Kim Si-Hyun, Jo Ik Hyun, Kang Jun, Joo Sun Young, Choi Jung-Hyun
Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Incheon St. Mary's Hospital, 56 Dongsu-ro, Bupyeong-gu, Incheon, 403-720, Republic of Korea.
Department of Pathology, College of Medicine, The Catholic University of Korea, Incheon St. Mary's hospital, Incheon, Republic of Korea.
BMC Infect Dis. 2016 Jun 17;16:298. doi: 10.1186/s12879-016-1631-y.
Trichophyton usually causes a superficial skin infection, affecting the outermost layer of the epidermis, the stratum corneum. In immunocompromised patients, deeper invasion into the dermis and even severe systemic infection with distant organ involvement can occur. Most cases of deeper dermal dermatophytosis described in the literature so far involved pre-existing superficial dermatophytosis.
We report a 68-year-old woman presented to our clinic with a 3-month history of palpable nodules on the right ankle without pre-existing superficial dermatophytosis. Magnetic resonance imaging showed multiple, well-demarcated, cystic lesions around the lateral malleolus, located in the subcutaneous or dermal layers. The sizes varied from 0.5 cm to 4 cm in diameter. The patient underwent complete excision of the lesions. Fungal culture yielded Trichophyton rubrum on Sabouraud dextrose agar. Histopathology showed organizing abscesses with degenerated fungal hyphae. After the 12-week oral itraconazole therapy, the lesions were completely resolved.
Dermatophytes should be considered as a possible cause of deep soft tissue abscesses in immunocompromised patients, even though there is no superficial dermatophytosis lesion.
毛癣菌通常引起浅表皮肤感染，影响表皮的最外层，即角质层。在免疫功能低下的患者中，可发生更深层侵入真皮，甚至出现累及远处器官的严重全身感染。迄今为止，文献中描述的大多数深层皮肤癣菌病病例都伴有先前存在的浅表皮肤癣菌病。
我们报告一名68岁女性，因右踝出现可触及结节3个月就诊于我院，之前并无浅表皮肤癣菌病病史。磁共振成像显示外踝周围有多个边界清晰的囊性病变，位于皮下或真皮层。大小直径从0.5厘米到4厘米不等。患者接受了病变的完整切除。真菌培养在沙氏葡萄糖琼脂上培养出红色毛癣菌。组织病理学显示有组织化的脓肿以及退化的真菌菌丝。口服伊曲康唑治疗12周后，病变完全消退。
即使没有浅表皮肤癣菌病病变，在免疫功能低下的患者中，皮肤癣菌也应被视为深部软组织脓肿的可能病因。
