播散性隱球菌病合併皮膚表徵─兩例病例報告─

播散性隱球菌病好發於免疫抑制的宿主，而皮膚的侵犯發生於10-20%的病例。皮膚隱球菌病缺乏獨特的臨床表徵，故不易正熟診斷。然而播散性隱球菌病的亡亡率為70-80%，早期診斷及治療可使其降為10-20%。我們報告兩例合併皮膚表徵的播散性隱球菌病。一例為接受腎臟移植，並罹患隱球菌腦膜炎的病患，最初以fluconazole治療，但於一個月後復發肺部及皮膚隱球菌病，其皮慮病灶似結節性紅斑，隨後改以amphotericin B及後續fluconazole強化治療成。另一例為糖尿病病患，因全身性感染長期使用多種廣效性抗生素，其隱球菌病病灶呈現多處皮下結節及血管炎，雖以amphotericin B治療，仍不幸因多重器官衰竭而死亡。總結來說，在免疫抑制的病患發生任何皮膚病灶皆應將隱球菌病列入鑑別診斷。雖然fluconazole較無腎毒性，amphotericin B仍為免疫抑制的病患之主要治療用藥。

關鍵字

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並列摘要

Disseminated cryptococcosis occurs mainly in immunocompromised hosts and has cutaneous involvement occurring in 10-20 % of cases. However, cryptococcal skin lesions have no unique or identifying features that alert one to the correct diagnosis. The mortality rate of disseminated cryptococcosis is 70-80 % and it can be reduced to 10-20 % with prompt diagnosis and treatment. We report two cases of disseminated cryptococcosis with cutaneous manifestations. One was a recipient of renal transplant who developed cryptococcal meningitis and was initially treated with fluconazole. Pulmonary and cutaneous cryptococcosis mimicking erythema nodosum relapsed one month after initial remission and were subsequently cured with amphotericin B followed by fluconazole consolidation therapy. The second patient, who had a history of diabetes mellitus and received prolonged broad spectrum antibiotics for multiple infections, presented with multiple subcutaneous nodules and vasculitis as the manifestations of cryptococcosis and expired due to multi-organ failures even after amphotericin B therapy. In conclusion, cyptococcosis should be considered as a differential diagnosis in immunocompromised patients with any cutaneous lesions. Although fluconazole is less nephrotoxic, amphotericin B remains the mainstay of therapy in immunocompromised patients.

並列關鍵字

Cryptococcus ； Erythema nodosum ； Subcutaneous nodules ； Renal transplant

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播散性隱球菌病合併皮膚表徵─兩例病例報告─

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