疣状瓶霉致暗色丝孢霉病一例  

A case of cutaneous phaeohyphomycosis caused by Phialophora verrucosa

作　　者：徐永豪[1] 李春阳[1] 赵杰[1] 王克玉[1] 郭淑兰[1] 苏英[1] 焦健[1] 胡勤峰[1] 

机构地区：[1]山东大学齐鲁医院皮肤科,济南250012

出　　处：《中华皮肤科杂志》2011年第11期809-811,共3页Chinese Journal of Dermatology

摘　　要：患者男，16岁，右面颊红斑、结痂，渐扩展11年。体检：右面颊6cm×10cm形状不规则暗红斑和斑块，轻度疣状增生，皮疹边界清晰，边缘见条索状瘢痕，上部见多处约0．5～1cm大小的破溃、结痂，痂皮较硬，压片未见果酱色小结节。多处痂皮下刮片直接镜检，见淡棕色、粗细不等、分支分隔的菌丝。25℃和35℃沙氏葡萄糖琼脂培养基或马铃薯葡萄糖琼脂培养基培养形成黑绿色绒毛状菌落，镜下见具领状结构的瓶形产孢细胞和花朵样排列的小分生孢子。组织病理学检查，PAS染色见大量分支分隔菌丝、假菌丝和酵母样细胞。rDNA种特异性序列与疣状瓶霉标准株CDC—B2152具有99．73％的相似度。诊断：疣状瓶霉引起的面部暗色丝孢霉病。治疗：两性霉素B、伊曲康唑治疗有效，停药后复发，目前应用伊曲康唑和特比萘芬继续治疗。A 16-year-old male presented with a ll-year history of progressively enlarging erythema and crusting on the right cheek. Physical examination revealed an irregularly shaped, sharply marginated, dark ery- thematous patch sized 6 cm× 10 cm and plaques with mild verrucous proliferation. There were strip-like scar at the margin of lesions and multiple ulcers measuring 0.5 to 1 em in diameter with firm crusts. No small jelly- colored nodules were observed. Direct microscopy of multiple scrapings under the crusts showed many light brown, septate, branching and irregular hyphae. Olivaceous-black woolly colonies grew at 25 ℃ and 35 ℃℃ on Sabouraud＇s dextrose agar and potato dextrose agar; flask-shaped eonidiogenous ceils with funnel-shaped collarettes and ellipsoidal conidia arranged in flower-like shape were observed microscopically. PAS staining showed numerous septate and branching hyphae, pseudohyphae and yeast-like cells. There was a 99.73% similarity in the species-specific rDNA sequence between the isolate and phialophora verrucosa standard strain CDC-B2152. The patient was diagnosed with cutaneous phaeohyphomycosis caused by Phialophora verrucosa. The lesion subsided after treatment with amphotericin B and itraconazole, hut recurred after drug withdrawal. Itraconazole and terbinafine were administered for the retreatment of this patient.

关 键 词：暗色丝孢霉病 疣状瓶霉 组织病理学检查 琼脂培养基 继续治疗 伊曲康唑 PAS染色 两性霉素B 

分 类 号：R756[医药卫生—皮肤病学与性病学]