头皮部原发性皮肤隐球菌病一例  

A case of primary cutaneous cryptococcosis on the scalp

作　　者：鞠梅[1] 陈伟[1] 冯素英[1] 林麟[1] 顾恒[1] 

机构地区：[1]中国医学科学院皮肤病研究所,南京210042

出　　处：《中华皮肤科杂志》2007年第8期470-472,共3页Chinese Journal of Dermatology

摘　　要：患者男,78岁,头皮红斑、水肿、破溃10天,轻度瘙痒,皮损发展迅速。检查见头皮部皮损境界清楚,表面坏死、溃疡、结痂,周围有一红晕。溃疡边缘处皮损组织病理检查,表皮角化过度伴角化不全,真皮纤维组织增生和混合炎性细胞浸润,PAS染色见大量的真菌孢子。头皮溃疡部分泌物细菌培养未生长;真菌学检查鉴定为新生隐球菌。将分离培养所得菌种稀释后接种至ICR小鼠(4只)的颅内进行致病性研究,4天时1只死亡,1周后处死剩余3只,取脑组织作墨汁涂片,见大量厚荚膜孢子,证实了其致病性。治疗:口服伊曲康唑0.2 g,每日2次,1个月后溃疡基本愈合,取表面皮屑再次行真菌培养阴性。5个月复查时,溃疡完全愈合,已有头发长出。A 78-year-old male was admitted to our hospital because of erythema, edema and ulcer on the scalp for about 10 days. Ten days prior to the presentation, small erythematous papules with mild pruritus occurred on the scalp. The lesion rapidly developed ulcer covered with necrotic crust in the center with a well-circumscribed border and an erythmatous halo. Histopathology, bacterial culture and fungal examination were carried out with specimens collected from the border of the ulcer. A mouse model was established to study the pathogenicity of the isolate. Histopathology showed hyperkeratosis and parakeratosis of epidermis, as well as proliferation of fibrous tissue and infiltration of mixed inflammatory cells in dermis. PAS stain demonstrated the presence of numerous spores. Bacterial culture was negative. Fungal culture yielded single yeast colonies. The urease and caffeic acid tests of the isolate were positive. The fungi were collected from the culture, diluted, and inoculated into four mice. Four days later, one mouse died; seven days later, the remaining three mice were killed, and ink staining of brain tissue from these mice found a mass of spores coated by thick capsules. The isolated strain was identified as Cryptococcus neoformans by the above findings. One month after the treatment with oral itraconazole 0.2 g twice a day, the ulcer improved, and fungal culture of the scales on the surface of the lesion was negative. Five months later, the ulcer completely healed and hair regrowth was observed.

关 键 词：隐球菌病 溃疡 伊曲康唑 

分 类 号：R756[医药卫生—皮肤病学与性病学]