Sato Yukie, Suzino Kazuyo, Suzuki Akiko, Fukasawa Natsuko, Ouchi Yui, Yaguchi Takashi, Sato Tomotaka
Department of Dermatology, National Hospital Organization Tokyo Medical Center Meguro Tokyo, Japan.
Med Mycol J. 2011;52(3):239-44. doi: 10.3314/mmj.52.239.
We report a case of primary cutaneous Aspergillus caldioustus infection caused by nerve block therapy. A 67-year-old Japanese woman had been treated with oral predonisolon and tacrolimus for adult-onset Still disease and interstitial pneumonia. She presented with a 2-month-history of the lesions on the left back. A biopsy specimen from the skin lesion revealed granulomatous inflammation with hyphae. Culture of the pus and the skin specimen confirmed the diagnosis of cutaneous Aspergillus infection. The sequence of β- tubulin gene was analyzed to confirm the mycological diagnosis and the causative agent was identified as A. caldioustus. The patient was treated with surgical removal of the lesions and oral 200 mg/day itraconazole but she died of infectious interstitial pneumonia due to Pneumocystis jiroveci and Cytomegalovirus infection Percutaneous infection may have been responsible for the incidence of localized infection. There was no evidence of systemic aspergillosis. A. caldioustus is an emerging opportunistic fungal pathogen in immunocompromised patients. Immunocompromised patients who have persistent traumatic atypical skin lesion need to be ruled out of such rare fungus infection. An opportunistic infection in Immunocompromised patients can be life-threatening and prompt treatment based on accurate diagnosis is important.
我们报告了一例因神经阻滞治疗引起的原发性皮肤卡尔迪奥斯曲霉菌感染病例。一名67岁的日本女性因成人斯蒂尔病和间质性肺炎接受口服泼尼松龙和他克莫司治疗。她左侧背部出现皮损已有2个月。皮肤病变的活检标本显示有肉芽肿性炎症伴菌丝。脓液和皮肤标本的培养确诊为皮肤曲霉菌感染。对β-微管蛋白基因序列进行分析以确认真菌学诊断，病原体被鉴定为卡尔迪奥斯曲霉菌。患者接受了手术切除病变组织，并口服200毫克/天的伊曲康唑，但她死于因耶氏肺孢子菌和巨细胞病毒感染引起的感染性间质性肺炎。经皮感染可能是局部感染发生的原因。没有证据表明存在全身性曲霉菌病。卡尔迪奥斯曲霉菌是免疫功能低下患者中一种新出现的机会性真菌病原体。有持续创伤性非典型皮肤病变的免疫功能低下患者需要排除这种罕见的真菌感染。免疫功能低下患者的机会性感染可能危及生命，基于准确诊断的及时治疗很重要。
