Veronaea botryosa所致的淋巴表皮性暗色絲孢菌病

吾人在此報告本土首例Veronaea botryosa所致之淋巴表皮性暗色絲砲菌病。一位罹患高血壓、慢性腎功能不全、冠心症併心房顫動的八十一歲男性病患，在左腳背出現一界限不明且逐漸擴大的暗紅色腫塊，其上可見多處膿疱及蓄膿。隨後，在延著左小腿朝近心端的淋巴腺方向上陸續出現更多顆蓄膿且疼痛的紅色結節。利用氫氧化鉀抹片及periodic acid-Schiff快速染色技術，可見膿液中有暗色分隔菌絲。組織切片下也可見真皮及皮下組織上層中呈現急慢性發炎性的細胞浸潤及膿瘍，其間有許多暗色分隔菌絲。病人於是接受切開引流，局部清創及低劑量每日200毫克itraconazole治療，同時密切追蹤血中毛地黃濃度。皮膚組織切片及膿液的黴菌培養均長出暗灰黑色鵝絨狀菌落，經形態學鑑定為veronaea botryosa。在治療十個月後，病灶逐漸消退，且黴菌培養轉為陰性。病人現仍接受每日200毫克itraconazole並持續門診追蹤中。

關鍵字

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並列摘要

We report herein an unusual case of lymphocutaneous phaeohyphomycosis caused by Veronaea botryose, which to our knowledge is the first case report in Taiwan. An 81-year-old male with hypertension, chronic renal insufficiency, coronary heart disease and atrial fibrillation developed an illdefined, dusky red, swelling plaque with a purulent discharge on his left dorsal foot for 3 months. Thereafter, several tender fluctuating erythematous papulonodules progressed upward along the lymphatics of the involved lower leg. Rapid diagnosis by potassium hydroxide smear and periodic acid-Schiff staining disclosed phaeoid septate hyphae within the pus. Histopathologic examination revealed mixed acute and chronic inflammation with abscess formation and the presence of dematiaceous septate hyphae in the dermis and upper subcutis. After incisional drainage and partial debridement, low-dose itraconazole (200 mg/ day) was given, and the serum digoxin level was closely monitored. The fungal cultures of the biopsied skin tissue and pus yielded grayish black, velvety colonies, and Veronaea botryose was identified based on morphological characteristics. After treatment for 10 months, the cutaneous lesions regressed gradually and repeated cultures turned negative. The patient is still taking itraconazole 200 mg per day and followed regularly.

並列關鍵字

Veronaea botryose ； Phaeohyphomycosis ； Lymphocutaneous syndrome

國際替代計量

Veronaea botryosa所致的淋巴表皮性暗色絲孢菌病

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