特殊形态的互隔链格孢引起皮肤链格孢病1例  

Cutaneous alternariosis caused by a special form of Alternaria alternata: a case report

作　　者：刘荣 郭艳阳 高继鑫 王刚 付萌 Liu Rong;Guo Yanyang;Gao Jixin;Wang Gang;Fu Meng(Xi′an Medical University,Xi′an 710068,China;Department of Dermatology,Xijing Hospital,Air Force Medical University,Xi′an 710032,China)

机构地区：[1]西安医学院,西安710068 [2]空军军医大学西京皮肤医院,西安710032

出　　处：《中华皮肤科杂志》2025年第3期245-249,共5页Chinese Journal of Dermatology

基　　金：陕西省自然科学基金(2020JM-323)。

摘　　要：患者女,58岁,主因右足红色丘疹、斑块、结痂伴疼痛、瘙痒14年入院就诊。皮肤科检查:右足及右踝见多发红色斑块,其间散在红色丘疹,部分斑块上覆盖中等量黄褐色痂皮,足趾与足背交界处见少许黄色渗出。皮损组织病理:角化过度、角化不全,表皮假上皮瘤样增生,表皮内可见中性粒细胞聚集,真皮内混合性炎症细胞浸润。从皮损组织中培养出3种不同形态菌落,分别为淡棕色颗粒状、黑色颗粒状、白棕色丝状菌落。丝状菌落显微镜下为棕色分生孢子形成长链,有短的圆柱形喙部。而黑色及浅棕色颗粒状菌落在显微镜下均为孢子簇集成团,内部见单个或多个分隔,部分孢子可见出芽,电镜进一步证实上述结构。3种菌落分子生物学鉴定为互隔链格孢(Alternaria alternata)。诊断:链格孢霉特殊形态引起的皮肤链格孢病。予口服伊曲康唑治疗7个月后,皮损痊愈,随访3年未见复发。A 58-year-old female patient presented with red papules,plaques,and scabs on her right foot accompanied by pain and itching for 14 years.Dermatological examination revealed extensive red plaques on her right foot and ankle,with scattered red papules in between;some of the plaques were covered with a moderate amount of yellow-brown crusts,and a few yellow exudates were observed at the junction of the toes and the dorsum of the foot.Histopathological examination of the skin lesions showed hyperkeratosis,parakeratosis,pseudoepitheliomatous hyperplasia,neutrophil aggregation in the epidermis,and mixed inflammatory cell infiltration in the dermis.Three different types of colonies were cultured from the skin lesion tissues:light brown granular colonies,black granular colonies,and white-brown filamentous colonies.Under the microscope,the filamentous colonies appeared as long chains of brown conidia with short cylindrical beaks,while the black and light brown granular colonies appeared as clusters of spores,with single or multiple septa inside,and some budding spores were observed.Electron microscopy further confirmed the above structures.Molecular biological analysis revealed that the three types of colonies were all identified as Alternaria alternata.The patient was diagnosed with cutaneous alternariosis caused by a special form of Alternaria alternata.After 7 months of treatment with oral itraconazole,the skin lesions healed,and no recurrence was observed during a 3-year follow-up.

关 键 词：链格孢病 互隔链格孢霉 分生组织生长 超微结构 动物实验 

分 类 号：R75[医药卫生—皮肤病学与性病学]