Ogawa Marília M, Alchorne Maurício M A, Barbieri Antonio, Castiglioni Mário L V, Penna Adriana Porto Benatti, Tomimori-Yamashita Jane
Department of Dermatology, Federal University of São Paulo, Brazil.
Int J Dermatol. 2003 Aug;42(8):622-5. doi: 10.1046/j.1365-4362.2003.01814.x.
One of the main complications of chromoblastomycosis is lymphedema. The purpose of this study was to evaluate the lymphatic system of the limbs of patients with chromoblastomycosis using lymphoscintigraphy. It is a reliable, objective and noninvasive means of supporting the diagnosis of lymphedema.
Lymphoscintigraphy was performed in seven patients with chromoblastomycosis, six with lesions in the lower limb and one in the upper limb. Tc-99 m dextran was injected into the interdigital spaces of the upper or lower extremities. The qualitative parameters analyzed were the visibilization of the lymph vessels and the lymph nodes, dermal backflow, and existence of collateral vessels. All patients were treated with the association of itraconazole and cryotherapy with liquid nitrogen.
Three out of the 14 extremities examined had lymphedema clinically, and the lymphoscintigraphy showed abnormalities in the qualitative parameters; whereas these parameters were normal in the extremities without lymphedema. During the treatment of chromoblastomycosis, a second lymphoscintigraphy exam was performed on 10 limbs and did not show any improvement of the previous lymphoscintigraphic alterations.
The qualitative lymphoscintigraphy was a reliable method to show the morphology of the lymph vessels and confirm objectively the diagnosis of lymphedema secondary to chromoblastomycosis. The association of oral itraconazole and cryotherapy did not modify the lymphatic alterations in chromoblastomycosis.
着色芽生菌病的主要并发症之一是淋巴水肿。本研究的目的是使用淋巴闪烁造影术评估着色芽生菌病患者肢体的淋巴系统。它是支持淋巴水肿诊断的一种可靠、客观且无创的方法。
对7例着色芽生菌病患者进行了淋巴闪烁造影术，其中6例下肢有病变，1例上肢有病变。将99m锝标记的右旋糖酐注入上肢或下肢的指间间隙。分析的定性参数包括淋巴管和淋巴结的显影、真皮回流以及侧支血管的存在情况。所有患者均接受伊曲康唑与液氮冷冻疗法联合治疗。
在检查的14个肢体中，有3个临床上存在淋巴水肿，淋巴闪烁造影术显示定性参数异常；而无淋巴水肿的肢体这些参数正常。在着色芽生菌病治疗期间，对10个肢体进行了第二次淋巴闪烁造影检查，先前的淋巴闪烁造影改变未显示任何改善。
定性淋巴闪烁造影术是一种可靠的方法，可显示淋巴管形态并客观地证实着色芽生菌病继发淋巴水肿的诊断。口服伊曲康唑与冷冻疗法联合应用并未改变着色芽生菌病的淋巴改变。
