CAJ | 학술논문

目的：播散性念珠菌病是一种致命性真菌感染性疾病，在免疫缺陷患者中发病率逐年增多，报道1例以双下肢多发皮下结节为首发表现，伴有肺及脑受累的播散性念珠菌病，并文献复习播散性念珠菌病的皮肤受累临床表现。方法患者女，37岁。因双下肢多发皮下结节6个月余就诊。有局灶节段性肾小球硬化病史，口服强的松及他克莫司2 a余。取患者皮损组织行病理学检查，皮损组织、脓液、血、痰、尿、粪、脑脊液进行真菌镜检及真菌培养，并文献检索统计播散性念珠菌病皮肤受累患者临床特点。结果皮损组织病理见假菌丝，皮损组织、脓液、痰、尿、粪标本直接涂片均见假菌丝并培养出白念珠菌，CT显示肺受累，诊断为播散性念珠菌病，予抗真菌治疗，患者皮损愈合及肺部病灶部分吸收，但因自行停药，最终出现颅内播散。结论以皮损为首发表现的播散性念珠菌病临床罕见，临床诊疗中应重视应用免疫抑制剂患者皮损的组织病理及微生物检查，及早进行诊断和治疗，防止出现系统性播散，从而降低死亡率。
목적：파산성념주균병시일충치명성진균감염성질병，재면역결함환자중발병솔축년증다，보도1례이쌍하지다발피하결절위수발표현，반유폐급뇌수루적파산성념주균병，병문헌복습파산성념주균병적피부수루림상표현。방법환자녀，37세。인쌍하지다발피하결절6개월여취진。유국조절단성신소구경화병사，구복강적송급타극막사2 a여。취환자피손조직행병이학검사，피손조직、농액、혈、담、뇨、분、뇌척액진행진균경검급진균배양，병문헌검색통계파산성념주균병피부수루환자림상특점。결과피손조직병리견가균사，피손조직、농액、담、뇨、분표본직접도편균견가균사병배양출백념주균，CT현시폐수루，진단위파산성념주균병，여항진균치료，환자피손유합급폐부병조부분흡수，단인자행정약，최종출현로내파산。결론이피손위수발표현적파산성념주균병림상한견，림상진료중응중시응용면역억제제환자피손적조직병리급미생물검사，급조진행진단화치료，방지출현계통성파산，종이강저사망솔。
Objective Disseminated candidiasis is a frequently fatal condition that is rising steadily in immunocompromised pa-tients We reported one case of disseminated candidiasis and reviewed currently available case reports on the cutaneous manifesta-tions of disseminated candidiasis Methods A 37-year-old woman with nodular on lower extremities as the initial presentation,in-volved of the lung and brain She had focal segmental glomerulosclerosis( FSG)undergoing therapy of tacrolimus and prednisone for two years Skin biopsies and culture of skin tissues,stools,urine and sputum were performed Results With microbiological evi-dence of Candida albicans in skin tissue and kinds of excretions except cerebrospinal fluid and blood Chest CT showed bilateral patchy infiltration She was diagnosed as disseminated candidiasis and had anti-fungal therapy A significant improvement of clinical symptoms and resolution of pulmonary were found in following days But she had diffuse brain dissemination after interruption of anti-fungal treatment by herself Conclusions Although widespread organ involvement is characteristic of disseminated candidiasis,re-ports of skin lesions are rare Early cultures and biopsies resulted in early diagnosis,which prompted proper antifungal therapy and a positive outcome.