Department of Dermatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Department of Microbiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Mycoses. 2019 Feb;62(2):121-127. doi: 10.1111/myc.12853. Epub 2018 Oct 17.
The incidence of cutaneous infections by dematiaceous fungi is rising in our environment due to the high number of solid organ transplant recipients (SOTR).
To review our experience in the management of cutaneous phaeohyphomycoses in a Spanish reference centre for dermatological care of SOTR.
Retrospective clinical, histopathological and microbiological review of all SOTR diagnosed of a phaeohyphomycosis in a 7-year period.
Eleven SOTR were identified (8 lung and 3 kidney). The lesions were solitary in six patients and multiple in five, affecting mostly the lower extremities. Early lesions showed epidermal hyperplasia and a diffuse dermal suppurative granulomatous infiltrate that was progressively substituted by fibrosis when the lesions were treated. Septated fungal structures with refractile walls were identified. DNA sequencing confirmed the presence of Alternaria spp (8 cases), Cladosporium cladosporioides, Microsphaeropsis arundinis and Exophiala oligosperma. Three patients with single lesions were treated with surgery, while the other 8 required long-term antifungal therapy, including itraconazole, voriconazole and/or terbinafine, combined with surgery and reduction in tacrolimus doses.
A clinical, histopathological and microbiological correlation is essential to corroborate this diagnosis. Solitary lesions are easily treated with surgery, but larger or multiple lesions may require long medical treatments combined with surgery and modification of immunosuppressive medication. The list of dematiaceous fungi implicated in cutaneous infections is expanding, in line with the availability of more sophisticated identification methods and the increasing number of immunosuppressed patients.
由于实体器官移植受者（SOTR）数量众多，环境中暗色真菌引起的皮肤感染发病率正在上升。
回顾我们在西班牙 SOTR 皮肤科护理参考中心对皮肤暗色丝孢霉病管理的经验。
回顾性分析了 7 年内所有被诊断为暗色丝孢霉病的 SOTR 的临床、组织病理学和微生物学资料。
共发现 11 例 SOTR（8 例肺部，3 例肾脏）。6 例患者的病变为单发，5 例为多发，主要影响下肢。早期病变表现为表皮增生和弥漫性真皮化脓性肉芽肿浸润，当病变得到治疗时逐渐被纤维化取代。可见分隔真菌结构，具有折射壁。DNA 测序证实存在拟青霉属（8 例）、枝孢霉属、小突孢属和寡孢外瓶霉。3 例单发病变患者接受手术治疗，而其余 8 例需要长期抗真菌治疗，包括伊曲康唑、伏立康唑和/或特比萘芬，联合手术和减少他克莫司剂量。
临床、组织病理学和微生物学的相关性对于证实这一诊断至关重要。单发病变容易通过手术治疗，但较大或多发性病变可能需要长期药物治疗联合手术和免疫抑制药物的调整。与更复杂的鉴定方法的可用性以及免疫抑制患者数量的增加相一致，与皮肤感染相关的暗色真菌种类正在不断扩大。
