Su Huilin, Li Li, Cheng Benlin, Zhu Junhao, Zhang Qiangqiang, Xu Jinhua, Zhu Min
Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, 200040, China.
Mycopathologia. 2017 Jun;182(5-6):549-554. doi: 10.1007/s11046-016-0099-z. Epub 2016 Dec 21.
Infections caused by Trichophyton rubrum are very common in dermatological disease. It most often appears as superficial cutaneous mycosis, such as tinea manuum, tinea pedis, and tinea corporis. However, deep infection caused by T. rubrum was rarely reported. We describe a case of mixed type of deep infection caused by T. rubrum in a 45-year-old man with no significant immunodeficiency. This patient had a history of onychomycosis on the toenails without regular treatment for nearly 6 years. And, he had erythema, papule, and nodules on the submandibular area, neck, and chest for almost 1 year. After treated with intravenous infusion of cefotiam for 2 weeks, the lesion aggravated. The fungal direct microscopic examination of pyogenic fluid was positive, and the fungal cultures that produced reddish-brown and yellow pigment showed cottony, wooly, and white colony. After the DNA sequencing, it was identified as T. rubrum. We gave the patient oral terbinafine 250 mg per day and bifonazole cream for external use. Six months later, the patient's skin lesion was disappeared, and healthy nail growth was seen in two-thirds of nail bed. The terbinafine is effective against deep infection caused by T. rubrum.
红色毛癣菌引起的感染在皮肤病中非常常见。它最常表现为浅表皮肤真菌病，如手癣、足癣和体癣。然而，由红色毛癣菌引起的深部感染鲜有报道。我们描述了一例由红色毛癣菌引起的混合型深部感染病例，患者为一名45岁男性，无明显免疫缺陷。该患者有近6年的 toenails 甲癣病史，未接受正规治疗。而且，他的下颌下区、颈部和胸部出现红斑、丘疹和结节近1年。静脉输注头孢替安治疗2周后，病情加重。脓性液体的真菌直接镜检呈阳性，产生红棕色和黄色色素的真菌培养显示为棉絮状、绒毛状和白色菌落。DNA测序后，鉴定为红色毛癣菌。我们给予患者每天口服250mg特比萘芬和外用联苯苄唑乳膏。6个月后，患者皮肤病变消失，三分之二的甲床可见健康指甲生长。特比萘芬对红色毛癣菌引起的深部感染有效。
