Manohar Arumugam, Nizlan Mohd N
Department of Orthopedic Surgery, Faculty of Medicine and Health Science, Universiti Putra Malaysia Jalan Puchong, 43400, Serdang, Selangor, Malaysia.
Orthopedics. 2008 Jul;31(7):710.
A 60-year-old man presented with a 3-month history of nonhealing ulcer over the tip of his right thumb. The ulcer started as a blister over the tip of the thumb that later ruptured and spread proximally to cover the whole pulp area of the thumb. There was no history of trauma, fever, weight loss, or loss of appetite. He is a pensioner and an avid gardener. He has a few cats as pets. The patient initially presented to a private orthopedic surgeon with a nonhealing ulcer of the right thumb. Multiple debridements were unsuccessful in ameliorating the ulcer. Three months after the onset of the initial lesion, multiple painless erythematous nodules had developed on his right arm, and one on the right thigh. All routine blood investigations were nondiagnostic. Swab culture from the ulcer failed to grow any organism and a course of antibiotics did not resolve the problem. Cultures of the biopsy specimen using Sabouraud's dextrose agar and potato carrot medium grew dark brown plaques that microscopically appeared to be branching hyphae. A diagnosis of sporotrichosis of the right upper limb was made and the patient was started on antifungal treatment immediately (T. Itraconazole [Sporanox] 200 mg BD). One month after commencement of antifungal treatment, the ulcer began to dry up and at 3 months all the lesions including the one on the right thigh had healed.
一名60岁男性，右拇指尖端有一个3个月未愈合的溃疡。溃疡起初是拇指尖端的一个水疱，后来破裂并向近端蔓延，覆盖了整个拇指的指腹区域。患者无外伤、发热、体重减轻或食欲减退史。他是一名退休人员，热衷于园艺。他养了几只猫作为宠物。患者最初因右拇指溃疡未愈合就诊于一名私人整形外科医生。多次清创术未能改善溃疡情况。最初病变出现三个月后，他的右臂出现了多个无痛性红斑结节，右大腿也有一个。所有常规血液检查均无诊断意义。溃疡拭子培养未培养出任何微生物，使用抗生素治疗一个疗程也未能解决问题。使用沙氏葡萄糖琼脂和马铃薯胡萝卜培养基对活检标本进行培养，长出了深褐色斑块，显微镜下可见分支菌丝。诊断为右上肢孢子丝菌病，患者立即开始抗真菌治疗（伊曲康唑[斯皮仁诺]200毫克，每日两次）。抗真菌治疗开始一个月后，溃疡开始干涸，3个月时所有病变包括右大腿上的病变均已愈合。
