萎缩型皮肤表现孢子丝菌病1例

Atrophic cutaneous sporotrichosis:a case report

患者,男,50岁,因“左前胸群集分布萎缩性斑片、丘疹1年半”就诊。既往于当地医院诊断为带状疱疹,间断治疗(具体不详),病情未明显好转。皮肤科检查:左前胸多个轻度萎缩性暗红斑片,米粒至黄豆大小暗红丘疹。皮损组织病理检查:棘层不规则增厚,真皮浅中层有大量淋巴细胞和浆细胞浸润,提示炎性肉芽肿改变。PAS染色可见圆形孢子。皮损组织沙堡弱培养基培养出深褐色绒毛状菌落,琼脂小培养并乳酸酚棉兰染色见细长分隔分枝菌丝和分生孢子,根据其表型特征可被鉴定为广义申克孢子丝菌(Sporothrix schenckii sensu lato),通过DNA测序鉴定该菌株为球形孢子丝菌(Sporothrix globosa),诊断为孢子丝菌病。口服伊曲康唑200 mg/d治疗4个月,症状消退,维持用药2~4周,6个月后随访无复发。

A male of 50 years old presented cluster-distributed atrophic patches and papules in the left anterior chest for one and a half years.Herpes zoster was previously diagnosed in the local hospital,but the condition did not improve after intermittent treatment.Dermatological examination of the left anterior chest showed atrophic dark red spots,dark red papules with the size of rice grains to soybeans.Histopathological examination of skin lesions showed that acanthal thickening,dermal lymphocyte and plasma cell infiltration,suggesting inflammatory granuloma changes.Periodic Acid-Schiff stain showed round spores.Dark brown villous colonies of skin lesions were cultured in Schaefer's medium.The mycelia and conidia of elongated segregated branches were observed by agar culture and lactic acid phenol-cotton stain.According to its phenotypic characteristics,it was identified as Sporothrix schenckii sensu lato,which is identifitied as sporothrix globosa by DNA sequencing.The diagnosis was sporotrichosis.Treatment:Oral itraconazole 200 mg/d treatment for 4 months,medication continued until the rash symptoms disappeared for 2 to 4 weeks,there was no recurrence after 6 months follow-up.