皮肤淋巴管型孢子丝菌病1例

A Case of Cutaneous Lymphatic Sporotrichosis

患者男,48岁,菜农。右侧手背及前臂红色丘疹、结节,不伴痛痒1月余。发病前有外伤史。皮肤科情况:右侧手背及前臂可见数个红色丘疹、结节和溃疡,呈线状分布。真菌直接镜检阴性;真菌培养见孢子丝菌复合体生长。组织病理呈感染性肉芽肿改变。扫描电镜可见分生孢子梗侧生或顶生分生孢子;全壁芽生孢子在基底部产生横隔,脱落后遗留有齿状突起。分子生物学、构建系统发育进化树鉴定结果为球形孢子丝菌。给予患者口服伊曲康唑联合特比萘芬,外用卢立康唑乳膏,治疗2个月后明显好转。

A 48-year-old male farmer presented red papules and nodule on the back of right hand and forearm without pain or itching for more than one month.He had injury before falling ill.Physical examination revealed multiple red papules,nodules and ulcers arranged in a line on the back of right hand and forearm.The direct microscopic examination was negative for fungi.Fungal culture showed the growth of sporotrichosis complex.Histopathological examination showed infective granuloma.Scanning electron microscopy showed conidial or terminal conidia of the conidiophore;the whole wall blast spores produced a transverse septum at the base,leaving dentate after the shedding.According to the results of molecular biology and phylogenetic tree construction,sporothrix globosa was identified.The patient was treated with itraconazole combined with terbinafine orally and ruiconazole cream topically.The lesions were obviously improved after 2-month treatment.