- 期刊
Cutaneous Hyalohyphomycosis Caused by Paecilomyces marquandii-A Case Report
Paecilomyces marquandii所致的皮膚透明菌絲黴菌病－病例報告
摘要
擬青黴菌屬(Paecilomyces species)是廣泛存在的腐物寄生的黴菌，但是很少造成人類的感染。我們報告一免疫功能低下的病人因感染P. marquandii而導致皮膚透明菌絲黴菌病。一位六十八歲男性罹患糖尿病、慢性阻塞性肺病及長期使用類固醇所導致醫源性庫興氏症候群，他於一個月前在農田裡摔倒，隨後在兩側下肢出現許多膿疱及化膿性潰瘍傷口。病患曾被診斷成蜂窩性組織炎並接受靜脈注射抗生素治療，但是皮膚病灶持續惡化。利用氫氧化鉀抹片檢查可見膿疱內有透明分隔菌絲。組織切片下可見緻密的急慢性發炎細胞浸潤，在periodic acid-Schiff及Gomori's methenamine-silver nitrate特殊染色在膿瘍內可見透明分隔菌絲及孢子。黴菌培養根據型態特徵鑑定為P. marquadii。在接受三個月的口服低劑量itraconazole(200mg/day)治療後，皮膚病灶逐漸改善。本例為台灣第一例報導由P. marquandii所引起的皮膚感染。
關鍵字
無資料並列摘要
Paecilomyces species are ubiquitous saprophytic fungi that rarely cause human infections. We report herein a case of an immunocompromised patient with cutaneous hyalohyphomycosis caused by P. marquandii. The 68-year-old male suffered from diabetes mellitus, chronic obstructive lung disease, and iatrogenic Cushing syndrome due to a prolonged use of a systemic steroid for asthma. He fell down in the farm while gardening and many pustules and fluctuating ulcerative nodules with pus discharge then developed gradually on bilateral lower extremities. He had been treated as having cellulitis with intravenous antibiotics but the skin lesions progressed. Direct light microscopy of pustule scrapings in potassium hydroxide (KOH) revealed hyaline fungal hyphae. A histopathologic examination revealed dense acute and chronic inflammatory cell infiltration with abscess formation. Both periodic acid-Schiff and Gomori's methenamine-silver nitrate stains demonstrated septate hyphae and spores in the abscess. Paecilomyces marquandii was identified based on the morphological characters in culture. The cutaneous lesions were lessened gradually after the treatment with low-dose oral itraconazole (200 mg/day) for 3 months. This is the first report of a cutaneous infection caused by P. marquandii in Taiwan.
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