免疫功能正常患者由微小根霉引起的皮肤毛霉病：一例报告并文献复习
Cutaneous mucormycosis caused by Rhizopus microsporus in an immunocompetent patient: A case report and review of literature.
作者信息
Wang Yilun, Zhu Min, Bao Yunqi, Li Li, Zhu Liping, Li Feng, Xu Jinhua, Liang Jun
机构信息
Department of Dermatology Department of Infectious Diseases, Hushan Hospital, Fudan University, Shanghai, China.
出版信息
Medicine (Baltimore). 2018 Jun;97(25):e11141. doi: 10.1097/MD.0000000000011141.
RATIONALE
Cutaneous mucormycosis is an uncommon disease and occurs rarely in immunocompetent patients.
PATIENT CONCERNS
We reported the case of a 37-year-old man presenting with a skin lesion on the left side of the chest wall with no history of trauma or primary diseases. He was firstly misdiagnosed as tuberculosis and the proper treatment was thus delayed.
DIAGNOSES
Histopathological examination and fungal culture of the lesion confirmed cutaneous mucormycosis. The isolate was identified as Rhizopus microspores by ITS sequencing.
INTERVENTIONS
The patient was treated with oral posaconazole 400 mg bid for 150 days.
OUTCOMES
The patient recovered satisfactorily. No recurrence was found during the follow-up and no side effect of liver function was found.
LESSONS
This case helps doctors to consider the possibility of serious fungal infection in immunocompetent patients. It also suggested that posaconazole could be an alternative choice for the treatment of mucormycosis considering the severe side effect of Amphotericin B.
理论依据
皮肤毛霉病是一种罕见疾病，在免疫功能正常的患者中很少发生。
患者情况
我们报告了一名37岁男性病例，该患者胸壁左侧出现皮肤病变，无创伤史或原发性疾病史。他最初被误诊为结核病，因此适当的治疗被延误。
诊断
病变的组织病理学检查和真菌培养证实为皮肤毛霉病。通过ITS测序将分离株鉴定为小孢子根霉。
干预措施
患者接受口服泊沙康唑400mg，每日两次，共150天的治疗。
结果
患者恢复良好。随访期间未发现复发，也未发现肝功能副作用。
经验教训
该病例有助于医生考虑免疫功能正常患者发生严重真菌感染的可能性。这也表明，考虑到两性霉素B的严重副作用，泊沙康唑可能是治疗毛霉病的替代选择。
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