Cardoso José Carlos, Serra David, Cardoso Raquel, Reis José Pedro, Tellechea Oscar, Figueiredo Américo
Serviço de Dermatologia, Hospitais da Universidade de Coimbra, Coimbra, Portugal.
Dermatol Online J. 2009 Oct 15;15(10):8.
We describe the case of a 59-year-old male renal transplant recipient who presented with a 1 month history of nodular, erythematous, and crusted lesions on the anterior surface of the left leg. There was no history of trauma. The patient had no systemic signs or symptoms. A skin biopsy revealed evidence of a deep fungal infection, with septate and branching hyphae amongst the dermal inflammatory infiltrate, but the culture was negative. Initial treatment with itraconazole proved ineffective and new lesions appeared. New tissue samples were obtained for culture, allowing the isolation of Pseudallescheria boydii. The patient underwent surgical excision of the lesions combined with voriconazole 400 mg/day for 2 months. After this period no new lesions appeared and the patient has remained without recurrence after 2 years of follow-up. Pseudallescheria boydii is an opportunistic fungus that can cause systemic infection mainly in immunocompromised patients that manifests as pulmonary, osteoarticular, ocular, vascular, cutaneous or central nervous system disease. Resistance to therapy can occur with infection progression and high mortality. Treatment with the combination of an antifungal agent, mainly voriconazole, and surgery, when feasible, probably provide the best results in cutaneous infections.
我们描述了一例59岁男性肾移植受者的病例，该患者左腿前表面出现结节性、红斑性和结痂性病变1个月。无外伤史。患者无全身症状或体征。皮肤活检显示有深部真菌感染的证据，在真皮炎症浸润中有分隔和分支的菌丝，但培养结果为阴性。最初使用伊曲康唑治疗无效，且出现了新的病变。获取新的组织样本进行培养，分离出了博伊德假阿利什菌。患者接受了病变的手术切除，并联合使用伏立康唑400毫克/天，持续2个月。在此期间，未出现新的病变，且患者在随访2年后未复发。博伊德假阿利什菌是一种机会性真菌，主要可在免疫功能低下的患者中引起全身感染，表现为肺部、骨关节、眼部、血管、皮肤或中枢神经系统疾病。随着感染进展可能会出现治疗耐药，且死亡率高。对于皮肤感染，联合使用抗真菌药物（主要是伏立康唑）并在可行时进行手术治疗，可能会取得最佳效果。
