絮状表皮癣菌和西弗念珠菌引起皮肤疣状增生:一例报告

Skin Verrucous Hyperplasia Caused b y Epidermophyton floccosum and Candida ciferrii:a Case Report

患者外伤数年后,先后在两足部、两踝部、两小腿出现皮肤疣状增生30余年,时有溃疡。治疗前皮损9次真菌学检查,直接镜检5次阳性,可见细长分隔菌丝和(或)孢子。用沙堡培养基25℃培养,2次有黄绿色菌落生长,鉴定为絮状表皮癣菌;5次有酵母样菌落生长,用API鉴定为西弗念珠菌。治疗后6次真菌学检查,均检出西弗念珠菌,而无絮状表皮癣菌。皮损组织病理学检查:表皮棘层、颗粒层和角质层内可见细长分隔菌丝,角质层内可见孤立或成堆的芽孢、孢子和厚壁孢子。因此,认为皮肤疣状增生是由絮状表皮癣菌和西弗念珠菌混合感染所致。先服用氟康唑胶囊50mg,每日1次,共5周,后服用特比萘芬片250mg,每日1次共36周和250mg,每日2次,共18周。服特比萘芬片第5周时,左小腿胫前有大块皮损脱落,以后疗效不明显。

Several years after trauma,a patien t suffered from skin verrucous hyperplasia for more than 30years,accompanied by ulcer occasio nally,on the feet,ankles and legs su ccessively.Mycological examinati on(9times)had been done before treatment.Slig ht septate hyphae and /or spores were demonstrated by direct mi-croscopy(5times);and yellowish green colony grew on S abouraud agar at 25℃for 2times,it wa s identified as Epidermophyton floccosum.Yeast -like colony grew on Sabourau d agar at 25℃for 5times,it was identi fied as Candida ciferrii by API.After treatment,Candida ciferrii could still be detected by mycologic al examination(6times),but no Epidermophyton floccosum was found.Slight septate hyphae were demonstrated in stratum spinosum,stratum granulosum and stratum corneum by histopathological examination.Isolated or clustered blastospores,spores and chlamydospores were demonstrated in stratum c orneum by histopathological examin ation.Therefore,it was concluded that the skin verrucous hyperplasia in this c ase is caused by mixed infection of Epidermophyton floccosum and Candida ciferrii.The patient was treated with flucon azole capsule 50mg daily for5weeks,followed by terbinafine tab let 250mg daily for 36weeks,and then250mg twice daily for 18weeks.In the 5th week of terbinafine therapy,a part of the lesions on the shin of left leg healed.No further therapeutic effect was observed.