肺结节病合并Alternaria alternata所致皮肤链格孢病1例

A case report of Alternaria alternate-induced cutaneous alternariosis in a patient with pulmonary sarcoidosis

患者,女,61岁,确诊肺结节病、口服糖皮质激素7月,双手背及腕部红色斑块3个月。组织病理示表皮轻度棘层增厚,真皮浅、中层中性粒细胞、淋巴、组织细胞、浆细胞、多核巨细胞混合性浸润,可见散在双轮廓厚壁酵母样结构。六铵银染色见不规则肿胀菌丝及酵母样厚壁孢子。真菌培养见棕/灰褐色菌落,镜下见棕色分隔孢子。ITS区序列分析鉴定为Alternaria alternate。口服伊曲康唑胶囊200 mg/d,联合外用硝酸舍他康唑乳膏2次/d,连续用药4个月后皮损完全消退,随访半年,未见复发。

Female,61-year-old,diagnosed with pulmonary sarcoidosis and treated with oral glucocorticoid for a period of 7 months.She was presented with red plaque in both dorsal hands and wrists for 3 months.Histology revealed mild acanthosis,mixed infiltration of neutrophils,lymphocytes,plasma cells and multinuclear giant cells was found in the superficial and middle dermis.Importantly,Scattered yeast-like structures with thick wall were noted in dermis.Irregular swollen hyphae and yeast-likes spore with thick wall were observed in Grocott's stain.In addition,brownish greycolony was isolated from the lesion.Brown septate spores were observed under microscopy.The colony was identified as Alternaria alternate by ITS sequencing.Oral itraconazole(200 mg/day)and topical sertaconazole nitrate cream(twice per day)were prescribed for 4 months.The lesions were subsided and no flare at half year follow-up.