播散性红色毛癣菌肉芽肿一例  

A case report of disseminated Trichophyton rubrum granuloma

作　　者：弓娟琴[1] 刘训荃[1] 曾学思[1] 徐宏彬[1] 陈炜[1] 胡素泉[1] 

机构地区：[1]中国医学科学院,中国协和医科大学皮肤病研究所,南京210042

出　　处：《国际皮肤性病学杂志》2006年第6期340-342,共3页International Journal of Dermatology and Venereology

摘　　要：目的报道1例播散性红色毛癣菌肉芽肿。方法对患者的临床资料、真菌学检查、组织病理及疗效进行分析。结果患者为46岁女性,手足、躯干红斑、脱屑30年,头皮、躯干、上肢结节、溃破2年。检查见头皮、颈、躯干和上肢有紫红色浸润性斑块、结节,部分皮损表面破溃、渗液、结痂。皮损内穿刺液及甲直接镜检菌丝阳性,培养为红色毛癣菌生长。皮损病理检查:真皮内可见上皮细胞样肉芽肿,其中央大片坏死,周围见结节样上皮样细胞团块,伴少许多核巨细胞、淋巴细胞及嗜酸粒细胞浸润。PAS染色真皮内见真菌菌丝。诊断为播散性红色毛癣菌肉芽肿。伊曲康唑治疗3个月后皮损消退,遗留萎缩性瘢痕。用药期间未见不良反应。结论播散性红色毛癣菌肉芽肿临床少见,伊曲康唑疗效满意。Objective To report a case of disseminated Trichophyton rubmm granuloma, and to evaluate the therapeutic effect of itraconazole. Methods The following evaluations were performed： clinical data, mycological and histopathological examinations, and effect of therapy. Results The patient was a 46-year-old woman, presented with erythema and scaling on the trunk, hands and feet for 30 years, as well as nodules and ulceration on the scalp, trunk and upper limbs for 2 years. Physical examination revealed purple-red infiltrated plaques and nodules on the scalp, neck, trunk and arms. Exudates, crusts and ulcers were noticed on the surface of some of the lesions. Direct microscopic examination of skin lesion aspiration and nail scrapings showed the presence of hyaline hyphae; fungal culture showed the growth of Trichoph.yton rubrum. Examination of the skin biopsy specimen revealed an epitheliod granuloma in the dermis infiltrated with several multinucleate giant cells, lymphocytes and eosinophils, the central area of which was necrotic and surrounded by nodular-like epithelioid cell masses. The periodic acid Schiff （ PAS ） staining was positive for fungal hyphae in the dennis. A diagnosis of disseminated Trichophyton rubrum granuloma was made. The patient was treated with a 3 month course of itraconazole; this resulted in the resolution of the lesions with atrophic scars. No side effects were observed during the treatment, Conclusion Disseminated Trichophyton rubmm granuloma is a rare disease, and itraconazole is effective for it.

关 键 词：发癣菌属 肉芽肿 伊曲康唑 皮肤真菌病 

分 类 号：R756[医药卫生—皮肤病学与性病学]