Stoneham A C S, Stoneham S E, Wyllie S A, Pandya A N
Department of Plastic Surgery, Salisbury NHS Foundation Trust, Salisbury, UK.
Department of Dermatology, St Mary's Hospital, Portsmouth, UK.
BMJ Case Rep. 2017 Jan 23;2017:bcr2016217923. doi: 10.1136/bcr-2016-217923.
A man aged 47 years who was immunosuppressed following renal transplantation for focal segmental glomerulosclerosis was referred to the Plastic Surgery team for management of a painful, chronic, granulomatous lesion of the right forearm. Serial ultrasound scans and MRI scans were not diagnostic, but microbiological specimens tested positive for the fungus Scedosporium apiospermum The renal transplant graft-which was failing-was removed, allowing him to cease immunosuppression. He then underwent a resection of the lesion and reconstruction with a split thickness skin graft. Analysis of the specimen revealed fibrosis, granulomatosis and a collection of S. apiospermum He was started on voriconazole which, in conjunction with his surgical resection, appears to have kept the disease at bay. With increasing numbers of solid organ transplants and improved survival, this case highlights the growing burden of rare, opportunistic infections, the difficulty in diagnosis and the need for specialist intervention.
一名47岁男性，因局灶节段性肾小球硬化接受肾移植后处于免疫抑制状态，因右前臂出现疼痛性慢性肉芽肿性病变而被转诊至整形外科团队。系列超声扫描和MRI扫描均未明确诊断，但微生物标本检测显示真菌尖端赛多孢子菌呈阳性。因移植肾失功，遂将其切除，患者得以停止免疫抑制治疗。随后，他接受了病变切除及中厚皮片移植重建术。标本分析显示有纤维化、肉芽肿形成以及尖端赛多孢子菌聚集。患者开始服用伏立康唑，结合手术切除，似乎已控制住病情。随着实体器官移植数量的增加及存活率的提高，该病例凸显了罕见机会性感染负担的日益加重、诊断的困难以及专科干预的必要性。
