Takeuchi Makoto, Yoshida Chikamasa, Ota Yusuke, Fujiwara Yutaka
Division of Hematology, National Hospital Organization Minami-Okayama Medical Center, Japan.
Intern Med. 2011;50(12):1339-43. doi: 10.2169/internalmedicine.50.4890. Epub 2011 Jun 15.
Infection of Scedosporium apiospermum is very rare but is now emerging as an important cause of both localized and disseminated infections in immunocompromised patients. A 62-year-old woman, who had undergone steroid therapy for refractory idiopathic thrombocytopenic purpura and had a history of diffuse large B cell lymphoma, developed a deep skin ulcer complicated with lymphangitis. After culture study demonstrated the presence of S. apiospermum, voriconazole (VRCZ) was administered and prompt improvement was observed. Because it is difficult to distinguish S. apiospermum from Aspergillus by histopathology and S. apiospermum is resistant to amphotericin B, VRCZ should be selected as the first choice of antifungal agent when mold is considered to be the causative organism.
尖端赛多孢菌感染非常罕见，但目前正成为免疫功能低下患者局部和播散性感染的重要原因。一名62岁女性，曾因难治性特发性血小板减少性紫癜接受类固醇治疗，并有弥漫性大B细胞淋巴瘤病史，出现了伴有淋巴管炎的深部皮肤溃疡。培养研究显示存在尖端赛多孢菌后，给予伏立康唑（VRCZ）治疗，病情迅速改善。由于通过组织病理学很难将尖端赛多孢菌与曲霉菌区分开来，且尖端赛多孢菌对两性霉素B耐药，当考虑霉菌为病原体时，应选择VRCZ作为抗真菌药物的首选。
