肾移植术后合并红色毛癣菌肉芽肿1例报道

A case of Majocchi's granuloma(MG)and onychomycosis caused by Trichophyton rubrumin a renal transplant recipient

报道1例肾移植术后红色毛癣菌肉芽肿病例。1位73岁老年女性患者,肾移植术后6年来一直口服小剂量的他克莫司和硫唑嘌呤,1个月前,其左小腿和足背出现豆大红色丘疹和结节,渐增大增多。患者有甲真菌病史10年,移植术后加重。病理和真菌学研究证明皮损是由红色毛癣菌引起的Majocchi肉芽肿。并通过基因分型的方法进一步证实Majocchi肉芽肿、足癣、甲真菌病都是同型别红色毛癣菌感染引起。根据药敏口服特比萘芬(500mg/d)和外用特比萘芬乳膏治疗12周后皮损消退。

We report a case of Majocchi＇s granuloma （MG） and onychomycosis caused by Trichophyton rubrum in a renal transplant recipient. The 73-year-old female patient had undergone left renal transplantation six years earlier for uremia and had been immunosuppressed with low daily doses of tacrolimus and azathioprine. While under this treatment, she presented with a one-month history of painful blue-red papules and nodules on an erythematous base on her left leg and both feet. She also had onychomycosis on toenails for ten years, which worsened post transplantation. We performed physical, pathological and mycological examination. The clinical diagnosis concluded that the disease was MG, onychomycosis and tinea pedis caused by Trichophyton rubrum . Further investigation demonstrated that the three strains isolated from the deep and superficial areas were identical. Oral intake of terbinafine tablets （500 mg/d） and topical application of terbinafine cream for 12 wks completely cured the lesions in the skin and nails.