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[免疫功能正常儿童的髂股皮肤毛霉菌病伴盆腔内蔓延]

[Iliofemoral cutaneous mucormycosis with endopelvic extension in an immunocompetent child].

作者信息

Elguazzar S, Benouachane T, Nasri A, Malihy A, Tligui H, Bentahila A

机构信息

Service de pédiatrie IV, faculté de médecine et pharmacie, université Mohammed V-Souissi, hôpital d'enfants, avenue Belarbi El Alaoui, BP 6203, Rabat, Maroc.

出版信息

Arch Pediatr. 2013 Jul;20(7):754-7. doi: 10.1016/j.arcped.2013.04.003. Epub 2013 May 22.

Abstract

Mucormycosis is a rare opportunistic fungal infection with clinical polymorphism and is rapidly extensive and destructive. It is caused by fungi of the mucorales group in the environment and generally arises in the context of immunosuppression. Often difficult and late, diagnosis is based on mycological and histological examination. We report the case of a 10-year-old patient admitted for a pruritic erythematous scaly eruption located in the right inguinal area associated with satellite lymphadenopathy and lymphedema of the right lower limb. The histological study of the cutaneous biopsy revealed a granulomatous reaction with filaments. The mycological examination of the collection of the cutaneous lesion showed mucorales filaments and a stump of Absidia corymbifera was isolated. Abdomino-pelvic CT showed muscular extension with vascular and ureteral englobement. The diagnosis of cutaneous mucormycosis was made. Immunological investigations were normal. Treatment included itraconazole for 3months followed by IV amphotericin B for 1month, with favorable clinical and radiological progression. Mucormycosis is an uncommon fungal infection whose cutaneous localization is rare. It occurs exceptionally in immunocompetent patients and is clinically manifested by a vesicular and pustular rash progressing to ulceration. The diagnosis is confirmed by mycological and histological studies. Treatment consists of antifungal therapy associated with surgical excision of necrotic and infected tissue.

摘要

毛霉病是一种罕见的机会性真菌感染,具有临床多态性,且迅速扩散并具有破坏性。它由环境中的毛霉目真菌引起,通常在免疫抑制的情况下发生。诊断往往困难且较晚,基于真菌学和组织学检查。我们报告一例10岁患者,因右腹股沟区瘙痒性红斑鳞屑疹入院,伴有卫星淋巴结病和右下肢淋巴水肿。皮肤活检的组织学研究显示有肉芽肿反应及菌丝。皮肤病变标本的真菌学检查显示有毛霉目菌丝,分离出一株伞状犁头霉。腹盆腔CT显示肌肉受累并累及血管和输尿管。诊断为皮肤毛霉病。免疫检查正常。治疗包括口服伊曲康唑3个月,随后静脉注射两性霉素B 1个月,临床和影像学进展良好。毛霉病是一种罕见的真菌感染,皮肤受累罕见。它在免疫功能正常的患者中极为罕见,临床表现为水疱和脓疱疹,进而发展为溃疡。通过真菌学和组织学研究确诊。治疗包括抗真菌治疗以及手术切除坏死和感染组织。

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