Stalkup Jennifer R, Bell Katherine, Rosen Ted
Department of Dermatology, Baylor College of Medicine, Houston Veterans Affairs Medical Center, Texas, USA.
Cutis. 2002 May;69(5):371-4.
A 72-year-old Hispanic man with diabetes presented with a 4-week history of a tender non-healing ulcer on the fifth digit of the left hand and a 3-day history of fever, chills, malaise, anorexia, and tender fluctuant nodules on the abdomen and left elbow. The patient, an avid gardener, was using prednisone and methotrexate for a debilitating seronegative polyarthropathy. A diagnosis of disseminated cutaneous sporotrichosis was made based on epidemiologic risk factors, clinical appearance, histopathologic examination, and a positive fungal culture. Use of prednisone was discontinued, the dosage of methotrexate was decreased, and use of oral itraconazole 400 mg/day was instituted. The patient's lesions cleared within 5 months, and no recurrence was noted during a 3-month follow-up. This case illustrates the typical association of the rare entity of disseminated cutaneous sporotrichosis with immunosuppression, an unusual lack of internal involvement, and a gratifying response to itraconazole.
一名72岁患有糖尿病的西班牙裔男性，左手小指出现一个疼痛且不愈合的溃疡，病程4周，同时伴有发热、寒战、乏力、厌食3天，腹部和左肘部出现压痛性波动结节。该患者是一位园艺爱好者，正在使用泼尼松和甲氨蝶呤治疗一种导致身体衰弱的血清阴性多关节炎。基于流行病学危险因素、临床表现、组织病理学检查及真菌培养阳性，诊断为播散性皮肤孢子丝菌病。停用泼尼松，减少甲氨蝶呤剂量，并开始口服伊曲康唑400mg/天。患者的皮损在5个月内消退，3个月随访期间未发现复发。该病例说明了播散性皮肤孢子丝菌病这一罕见疾病与免疫抑制的典型关联、不常见的无内脏受累情况以及对伊曲康唑的良好反应。
