O'Riordan Edmond, Denton John, Taylor Paul M, Kerr Jonathan, Short Colin D
Manchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Oxford Road, Manchester, UK M13 9WL.
Transplantation. 2002 Jan 15;73(1):151-3. doi: 10.1097/00007890-200201150-00029.
We report the case of an ethnic Asian patient who attended the renal transplant follow-up clinic complaining of pain in the right great toe. He had undergone transplantation nine months earlier and was maintained on triple immunosuppression. Initially, a clinical diagnosis of gout was made and the patient treated with analgesia. Two weeks later he remained symptomatic and developed a discharging sinus on his toe. A plain X-ray revealed a lytic lesion with minimal periosteal reaction. Aspiration of his first right metatarsal phalangeal joint was performed and fungal hyphae were observed in the fluid. Subsequently, despite surgical debridement and treatment with Itraconozaole amputation of the toe was required. Microbiological analysis revealed the organism to be Madurella grisea,which was resistant to both Itraconazole and Amphotericin B. He has remained well since amputation. We believe this to be the first case of Madurella infection to be described in a transplant patient.
我们报告了一名亚裔患者的病例，该患者前往肾移植随访门诊，主诉右大脚趾疼痛。他在九个月前接受了移植手术，目前维持三联免疫抑制治疗。最初，临床诊断为痛风，并对患者进行了镇痛治疗。两周后，他仍有症状，且脚趾出现了一个排脓窦道。X线平片显示有一个溶骨性病变，骨膜反应轻微。对其右第一跖趾关节进行了穿刺抽吸，在抽出液中观察到了真菌菌丝。随后，尽管进行了手术清创并使用伊曲康唑治疗，但仍需要截趾。微生物分析显示该病原体为灰马杜拉放线菌，它对伊曲康唑和两性霉素B均耐药。自截趾后他情况一直良好。我们认为这是移植患者中首例被描述的马杜拉放线菌感染病例。
