以皮肤受累为首发表现的播散性念珠菌病1例并文献复习

A case of cutaneous manifestations as an initial presentation of disseminated candidiasis

目的播散性念珠菌病是一种致命性真菌感染性疾病,在免疫缺陷患者中发病率逐年增多,报道1例以双下肢多发皮下结节为首发表现,伴有肺及脑受累的播散性念珠菌病,并文献复习播散性念珠菌病的皮肤受累临床表现。方法患者女,37岁。因双下肢多发皮下结节6个月余就诊。有局灶节段性肾小球硬化病史,口服强的松及他克莫司2 a余。取患者皮损组织行病理学检查,皮损组织、脓液、血、痰、尿、粪、脑脊液进行真菌镜检及真菌培养,并文献检索统计播散性念珠菌病皮肤受累患者临床特点。结果皮损组织病理见假菌丝,皮损组织、脓液、痰、尿、粪标本直接涂片均见假菌丝并培养出白念珠菌,CT显示肺受累,诊断为播散性念珠菌病,予抗真菌治疗,患者皮损愈合及肺部病灶部分吸收,但因自行停药,最终出现颅内播散。结论以皮损为首发表现的播散性念珠菌病临床罕见,临床诊疗中应重视应用免疫抑制剂患者皮损的组织病理及微生物检查,及早进行诊断和治疗,防止出现系统性播散,从而降低死亡率。

Objective Disseminated candidiasis is a frequently fatal condition that is rising steadily in immunocompromised pa-tients We reported one case of disseminated candidiasis and reviewed currently available case reports on the cutaneous manifesta-tions of disseminated candidiasis Methods A 37-year-old woman with nodular on lower extremities as the initial presentation,in-volved of the lung and brain She had focal segmental glomerulosclerosis（ FSG）undergoing therapy of tacrolimus and prednisone for two years Skin biopsies and culture of skin tissues,stools,urine and sputum were performed Results With microbiological evi-dence of Candida albicans in skin tissue and kinds of excretions except cerebrospinal fluid and blood Chest CT showed bilateral patchy infiltration She was diagnosed as disseminated candidiasis and had anti-fungal therapy A significant improvement of clinical symptoms and resolution of pulmonary were found in following days But she had diffuse brain dissemination after interruption of anti-fungal treatment by herself Conclusions Although widespread organ involvement is characteristic of disseminated candidiasis,re-ports of skin lesions are rare Early cultures and biopsies resulted in early diagnosis,which prompted proper antifungal therapy and a positive outcome.