CAJ | 학술논문

患儿男,14个月.因左侧颞、颈、胸部相继发生红斑片、丘疹、结节、脓肿、溃疡伴反复发热、咳嗽9个月,门诊疑诊皮肤结核、深脓疱疮、孢子丝菌病收住院.左上胸皮损组织病理检查,显示为炎性肉芽肿,PAS染片内有大量孢子和菌丝.左颈坏死组织压片PAS染色镜检,发现大量菌丝,真菌培养及鉴定均为白念珠菌.超敏C反应蛋白(14.4 mg/L)显著高于正常.总T细胞比例40.21%,CD3/CD4(26.41%)下降;抗获得性免疫缺陷病毒抗体阴性.胸部X线片及CT检查均显示双肺感染.先后给予氟康唑和伊曲康唑抗真菌治疗,经抗生素、免疫调节剂和支持治疗3个月皮损痊愈,伊曲康唑维持治疗8个月肺部炎症减轻.
환인남,14개월.인좌측섭、경、흉부상계발생홍반편、구진、결절、농종、궤양반반복발열、해수9개월,문진의진피부결핵、심농포창、포자사균병수주원.좌상흉피손조직병리검사,현시위염성육아종,PAS염편내유대량포자화균사.좌경배사조직압편PAS염색경검,발현대량균사,진균배양급감정균위백념주균.초민C반응단백(14.4 mg/L)현저고우정상.총T세포비례40.21%,CD3/CD4(26.41%)하강;항획득성면역결함병독항체음성.흉부X선편급CT검사균현시쌍폐감염.선후급여불강서화이곡강서항진균치료,경항생소、면역조절제화지지치료3개월피손전유,이곡강서유지치료8개월폐부염증감경.
A fourteen-month-old boy presented with a 9-month history of erythema,papules,nodules,abscesses and ulcers on left temple,neck and chest accompanied by fever and cough.He was hospimlized for suspected tuberculosis cutis,ecthyma and sporotrichosis.Hismpathology of nodules on the top of left chest showed a change characteristic of inflammatory granuloma with the presence of numerous fungal spores and hyphae.Under a microscope,a large number of hyphae were also observed in necrotic tissue specimen from the left neck with PAS staining.Fungal strains were isolated from both lesions and identified as Candida albicans.Laboratory examination revealed an increase in the serum leveI of hypersensitivity C reactive protein(14.4 mg/L)along with a decrease in total T cell proportion(40.21%)and the ratio of helper T cells to inducer T cells (26.4 1%).Anti-human immunodeficiency virus antibody was negative in this patient.Chest X-ray and computerized tomographic scanning(CT)showed an infection in bilateral lower lungs.After 3-month combined therapy with fluconazole,itraconazole,antibiotics,immunomodulators and supportive treatment,skin lesions were improved,and the lung infection was controlled after 8-month maintenance therapy with itraconazole.