中华皮肤科杂志 ›› 2022, Vol. 55 ›› Issue (11): 996-999.doi: 10.35541/cjd.20210718

• 研究报道 • 上一篇    下一篇

链格孢霉致播散型皮肤链格孢病3例临床分析

郭艳阳    高继鑫    海璐明    闫东    朱冠男    马翠玲    王刚    付萌   

  1. 第四军医大学西京皮肤医院，西安  710032 
  • 收稿日期:2021-09-30 修回日期:2022-08-07 发布日期:2022-11-03
  • 通讯作者: 付萌 E-mail:fumeng@fmmu.edu.cn
  • 作者简介:作者希望10月前发表。7.4
  • 基金资助:
    陕西省自然科学基金（2020JM-323）

Clinical analysis of three cases of disseminated cutaneous alternariosis caused by Alternaria

Guo Yanyang, Gao Jixin, Hai Luming, Yan Dong, Zhu Guannan, Ma Cuiling, Wang Gang, Fu Meng   

  1. Department of Dermatology, Xijing Hospital, The Fourth Military Medical University, Xi′an 710032, China
  • Received:2021-09-30 Revised:2022-08-07 Published:2022-11-03
  • Contact: Fu Meng E-mail:fumeng@fmmu.edu.cn
  • Supported by:
    Natural Science Foundation of Shaanxi Province of China（2020JM-323）

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摘要： 【摘要】 目的 分析3例链格孢霉致播散型皮肤链格孢病临床表现、组织病理、真菌病原学特征及治疗。方法 回顾分析2019—2021年西京皮肤医院诊断的3例链格孢霉致播散型皮肤链格孢病的临床特征、组织病理、真菌培养和菌株鉴定结果及治疗。结果 3例患者年龄分别为55、41和46岁，男1例、女2例。2例患有肾病综合征，1例患有系统性红斑狼疮，均有不同时间糖皮质激素及他克莫司治疗史，均为慢性病程。皮损HE染色可见双轮廓厚壁孢子及木节状厚壁有隔菌丝，均未见黑素。内转录间隔区测序显示，2例致病真菌为互隔链格孢霉，1例为侵染链格孢霉。不同温度培养显示，链格孢霉在35 ℃以上生长能力明显下降。3例患者均将他克莫司减量至标准剂量的1/3以下或改用其他免疫抑制剂，并同时给予系统抗真菌治疗，均取得较好疗效。结论 播散型皮肤链格孢病具有双侧分布的血行播散及单侧肢体的淋巴管分布特点，皮损以覆盖痂皮的疣状斑块、结节和/或窦道为特点。

关键词: 链格孢病, 皮肤表现, 播散型皮肤链格孢病, 链格孢霉, 厚壁孢子

Abstract: 【Abstract】 Objective To analyze clinical manifestations, histopathological and pathogenic fungus characteristics as well as treatment of 3 cases of disseminated cutaneous alternariosis caused by Alternaria. Methods Clinical data were collected from 3 cases of disseminated cutaneous alternariosis caused by Alternaria, who were diagnosed in Department of Dermatology, Xijing Hospital from 2019 to 2021, and clinical and histopathological features, fungal culture, strain identification and treatment results were retrospectively analyzed. Results The 3 patients were aged 55, 41 and 46 years respectively, including 1 male and 2 females. Two patients were previously diagnosed with nephrotic syndrome and 1 with systemic lupus erythematosus. All the patients had a history of taking glucocorticoids and tacrolimus for different durations, and experienced chronic infections. Histopathological examination with hematoxylin and eosin （HE） staining showed double-contour thick-walled spores and knot-shaped thick-walled septal hyphae, but no melanin in skin lesions. Sequencing of the fungal internal transcribed spacer region confirmed that 2 cases were infected with Alternaria alternate, and 1 with Alternaria infectoria. Fungal culture at different temperatures showed that the growth ability of Alternaria markedly decreased at the temperature over 35 ℃. To treat these patients, the dose of tacrolimus was reduced to less than 1/3 of the standard dose, or tacrolimus was switched to other immunosuppressants, and systemic antifungal therapy was also given at the same time. After 7-month treatment, good clinical outcomes were achieved in the 3 patients. Conclusion Disseminated cutaneous alternariosis is characterized by bilateral hematogenous dissemination and lymphatic distribution in unilateral limbs, and the skin lesions are characterized by verrucous plaques covered with scabs, nodules and/or sinuses.

Key words: Alternariosis, Skin manifestations, Disseminated cutaneous alternariosis, Alternaria, Chlamydospore