茎点霉致泛发性嗜酸性脓疱性毛囊炎1例及实验分析  

Eosinophilic pustular folliculitis caused by Phoma sp.

作　　者：孙一丹 李心悦 孙婷婷[1] 李东明[1] SUN Yi-dan;LI Xin-yue;SUN Ting-ting;LI Dong-ming(Department of Dermatology,Peking University Third Hospital,Beijing 100191)

机构地区：[1]北京大学第三医院皮肤科

出　　处：《中国真菌学杂志》2019年第5期303-307,共5页Chinese Journal of Mycology

基　　金：国家自然科学基金(81571967,C31770013)

摘　　要：目的报道1例顽固性嗜酸性脓疱性毛囊炎,并对其病因、诊断及治疗方法进行研究讨论。方法患者男性,47岁,头面部丘疱疹1年伴瘙痒,泛发,并出现血嗜酸性粒细胞增多3个月就诊。取皮损组织和骨髓进行组织分别进行HE、PAS、PASM、钙荧光白染色;同时进行组织真菌培养;真菌特异性引物ITS4/ITS5、NL1/NL5、T1/TUB4Rd测序。结果组织病理可见以毛囊为中心的嗜酸性毛囊化脓性炎,PAS染色和钙荧光白染色可见真皮、皮下组织大量不规则菌丝和孢子,毛囊及毛囊周围显著;骨髓PASM染色可见大量芽生孢子,组织及骨髓组织培养见绒毛状菌落,初期为粉红色,渐变为黑褐色,培养4周见黑色子囊形成;序列鉴定为茎点霉属;抗真菌治疗后痊愈。结论嗜酸性脓疱性毛囊炎可由真菌感染诱发;作为植物致病菌的茎点霉属感染可导致严重的变态反应,并可诱发嗜酸性脓疱性毛囊炎。Objective To report a rare case of eosinophilic pustular folliculitis(EPF)caused by Phoma.And to discuss the causes,diagnosis and treatment of that case.Methods A 47-year-old male patient with facial erythema,follicular papules,pustules with itching for 1 year,with peripheral blood eosinophils increased came to our hospital.The disease was initiated with follicular papules on his forehead that gradually spreading to the entire face,scalp,upper chest and back.He was treated with conventional drugs but did not respond.Biopsies of skin tissue and bone marrow were performed both for histopathological and microbiological studies with SDA,BHI.Results Histopathology showed hair follicle-centered eosinophilic pustular folliculitis,PAS staining and Calcofluor white staining showed blastospores and irregular hyphae.A large number of blastospores were observed in the bone marrow samples,which were intensified with Periodic acid-silver metheramine(PASM)staining.Morphological and DNA sequencing identification of culture showed the result of Phoma.It was speculated that infection with Phoma leads to eosinophilic pustular folliculitis.The patient was successfully treated with itroconazole,fluconazole and sataconazole.Conclusions The results showed that there was an infection of Phoma in that patient.After the anti-fungal treatment,the lesion was obviously getting better.It was determined from the etiology that the patient’s eosinophilic pustular folliculitis was caused by infection with Phoma.

关 键 词：嗜酸性脓疱性毛囊炎 真菌感染 茎点霉 

分 类 号：R519.8[医药卫生—内科学]