Quimby S R, Connolly S M, Winkelmann R K, Smilack J D
Section of Dermatology, Mayo Clinic Scottsdale, AZ 85259.
J Am Acad Dermatol. 1992 Jan;26(1):79-85. doi: 10.1016/0190-9622(92)70011-4.
Disseminated coccidioidomycosis merits greater attention because the number of persons living and traveling in endemic areas is increasing.
Our purpose was to study the clinical and histopathologic findings in patients with specific cutaneous disseminated coccidioidomycosis.
In six patients with specific skin lesions of disseminated coccidioidomycosis, the diagnosis was confirmed by identification of the organism in tissue or by positive results of tissue culturing.
Clinical lesions included solitary granulomatous plaques in two patients and multiple papular, nodular, or pustular lesions in four patients, two of whom also had subcutaneous abscesses. Identifying organisms directly in tissue was possible in only 8 of 17 biopsy specimens and in five of six patients. The histopathologic features showed various degrees of three primary patterns: (1) abscess formation with necrosis, (2) epithelial hyperplasia and granuloma formation with microabscesses, and (3) vascular and perivascular proliferative and inflammatory cell reactions at times suggesting vasculitis. Tissue eosinophilia, present in all patients, was striking in two (eosinophilic abscess formation) and notable in another (vascular inflammation with eosinophilia).
Cutaneous manifestations of disseminated coccidioidomycosis may be more common and varied than usually recognized.
由于在流行地区生活和旅行的人数不断增加，播散性球孢子菌病值得更多关注。
我们的目的是研究特定皮肤播散性球孢子菌病患者的临床和组织病理学表现。
在6例有播散性球孢子菌病特定皮肤病变的患者中，通过在组织中鉴定病原体或组织培养阳性结果确诊。
临床病变包括2例患者的孤立性肉芽肿性斑块以及4例患者的多发丘疹、结节或脓疱性病变，其中2例还伴有皮下脓肿。在17份活检标本中，仅8份以及6例患者中的5例能够直接在组织中鉴定出病原体。组织病理学特征呈现出三种主要模式的不同程度表现：（1）伴有坏死的脓肿形成；（2）上皮增生和伴有微脓肿的肉芽肿形成；（3）血管及血管周围的增殖性和炎症细胞反应，有时提示血管炎。所有患者均存在组织嗜酸性粒细胞增多，其中2例显著（嗜酸性脓肿形成），另1例明显（伴有嗜酸性粒细胞增多的血管炎症）。
播散性球孢子菌病的皮肤表现可能比通常认识到的更为常见和多样。
