CAJ | 학술논문

患者男,53岁,农民.10年前右手背出现一小疖肿,外用红霉素软膏2周后治愈.1个月后右手背出现一蚕豆大皮肤溃疡,经抗感染治疗后愈合,但皮损处皮肤增厚,长期外用皮炎平乳膏未见明显好转.2006年3月26日就诊.发病期间无发热.无糖尿病、结核病等慢性病及外伤史.体检:右手背皮肤见一不规则疣状斑块,约2.5 cm×4 cm大小,有少许渗液.其他部位皮肤未见异常.口腔分泌物及尿沉渣真菌检查均为阴性.皮损KOH镜检见棕色孢子,沙氏葡萄糖琼脂培养基培养出局限、绒状、墨绿色菌落,镜下见枝孢产生具分枝的球形分生孢子链.DNA序列分析显示,该菌株26S rDNA D1/D2序列与GeneBank中的球孢枝孢(AB100654)相差2个碱基,ITS序列与球孢枝孢(AM176719)相同,与球孢枝孢(AY625063)相差5个碱基.结合上述发现及微量培养等结果,该菌株鉴定为球孢枝孢.皮损组织HE染色显示肉芽肿相,PAS染色见棕色孢子,结合真菌学检查结果,诊断为皮肤暗色丝孢霉病.体外药敏试验显示该菌株对伊曲康唑敏感.给予患者口服伊曲康唑0.2 g/d,连续8周,皮损明显消退,但2个月后失访.
환자남,53세,농민.10년전우수배출현일소절종,외용홍매소연고2주후치유.1개월후우수배출현일잠두대피부궤양,경항감염치료후유합,단피손처피부증후,장기외용피염평유고미견명현호전.2006년3월26일취진.발병기간무발열.무당뇨병、결핵병등만성병급외상사.체검:우수배피부견일불규칙우상반괴,약2.5 cm×4 cm대소,유소허삼액.기타부위피부미견이상.구강분비물급뇨침사진균검사균위음성.피손KOH경검견종색포자,사씨포도당경지배양기배양출국한、융상、묵록색균락,경하견지포산생구분지적구형분생포자련.DNA서렬분석현시,해균주26S rDNA D1/D2서렬여GeneBank중적구포지포(AB100654)상차2개감기,ITS서렬여구포지포(AM176719)상동,여구포지포(AY625063)상차5개감기.결합상술발현급미량배양등결과,해균주감정위구포지포.피손조직HE염색현시육아종상,PAS염색견종색포자,결합진균학검사결과,진단위피부암색사포매병.체외약민시험현시해균주대이곡강서민감.급여환자구복이곡강서0.2 g/d,련속8주,피손명현소퇴,단2개월후실방.
A 53-year-old male patient was admitted to the hospital on March 26, 2006. Ten years prior to the presentation, a small furuncle developed on the dorsum of his right hand, and subsided after 2-week treatment with erythromycin ointment; one month later, a broadbean-sized cutaneous ulcer developed on the dorsum of the same hand. After anti-infective treatment, the ulcer healed while the lesional skin thickened, and long-term topical treatment with compound dexamethasone acetate cream showed no obvious effect Dermatological examination revealed an irregular verrucous plaque measuring 2.5 cm × 4 cm with little exudation on the dorsum of the right hand. KOH preparation of the skin lesion revealed brown spores. Sabouraud's dextrose agar culture grew restricted, velvety and dark green colony, and microscopy revealed branched, globular conidiophores generated by cladospores. DNA sequencing showed that the isolate was different from Cladosporium sphaerospermum (AB100654) by 2 bases in the sequence of D1/D2 region of 26S rDNA, from Cladosporium sphaerospermum (AY625063) by 5 bases in the sequence of internal transcribed spacer 1 and 2 (ITS 1 and ITS 2), but fully consistent with Cladosporium sphaerospermum (AM 176719) in the sequence of ITS region. The isolate was identified as Cladosporium sphaerospermum. Hematoxylin-eosin stain of the lesional tissue revealed granulomatous changes,and PAS stain demonstrated brown spores. A diagnosis of phaeohyphomycosis was made. Antifungal susceptibility testing indicated that the isolate was highly sensitive to itraconazole. The lesion obviously subsided after treatment with oral itraconazole 0.2 g once daily for 8 weeks, but the patient was lost to follow up 2 months later.