Brod Corinna, Benedix Frauke, Röcken Martin, Schaller Martin
Universitäts-Hautklinik, Eberhard-Karls-Unievrsität Tübingen, Tübingen, Germany.
J Dtsch Dermatol Ges. 2007 Jul;5(7):591-3. doi: 10.1111/j.1610-0387.2007.06283.x.
A 68-year-old man presented with a one month history of painful blue-red papules and nodules on an erythematous base on the top of his feet, as well as dystrophic toenails. He had undergone renal transplantation six months previously for membranous glomerulonephritis, and was immunosuppressed with tacrolimus 3 g, mycophenolate mofetil 1500 mg and prednisolone 5 mg daily. His tacrolimus level was 29.8 ng/ml (expected level 6-8 ng/ml). Even though the cutaneous lesions strongly suggested Kaposi sarcoma, the histological examination revealed a dermal abscess in which hyphae and spores were seen with PAS staining. ELISA-PCR of the biopsy identified Trichophyton rubrum, which was also grown on culture of the biopsy tissue. The diagnosis of Majocchi granuloma secondary to excessive immunosuppression was made. Systemic treatment with terbinafine 250 mg per day and topical ciclopirox olamine completely cured the granulomatous skin lesions, and later the nails.
一名68岁男性患者，足部顶端出现有疼痛的蓝红色丘疹和结节，基底为红斑，伴有甲营养不良，病程1个月。他6个月前因膜性肾小球肾炎接受了肾移植，目前每日服用他克莫司3毫克、霉酚酸酯1500毫克和泼尼松龙5毫克进行免疫抑制治疗。他的他克莫司血药浓度为29.8纳克/毫升（预期浓度为6 - 8纳克/毫升）。尽管皮肤损害强烈提示为卡波西肉瘤，但组织学检查显示为真皮脓肿，经PAS染色可见菌丝和孢子。活检组织的ELISA - PCR检测鉴定为红色毛癣菌，活检组织培养也培养出该菌。诊断为免疫抑制过度继发的Majocchi肉芽肿。每天口服250毫克特比萘芬并外用环吡酮胺进行系统治疗，完全治愈了肉芽肿性皮肤损害，随后指甲病变也得以治愈。
