Baline Kenza, Hali Fouzia
Service de Dermatologie et de Vénéréologie, CHU Ibn Rochd, Casablanca, Maroc.
Pan Afr Med J. 2018 Jun 28;30:187. doi: 10.11604/pamj.2018.30.187.5326. eCollection 2018.
We report the case of a 13-year old female patient from rural areas presenting with papulonodular lesion of 4/3cm in the lower third of the right leg, evolving over the last two years. Skin biopsy showed papillomatous hyperplasia with neutrophilic microabscess and spores. Direct mycological examination showed fumagoid bodies and Fonsecaea pedrosoi was isolated from culture. The patient underwent medico-surgical treatment (terbinafine 250mg/day for 6 months + resection and then skin graft) with good evolution and a follow-up period of 2 years without recurrences. Chromoblastomycosis is a chronic fungal skin infection, common in tropical and subtropical areas and rare in North Africa. In Morocco, only seven cases have been reported in the literature until June 2014. It is contracted from inoculation of germ after contact with the soil or organic matters. Responsible officers are pigmented fungi belonging to the dematiated group. Given its rarity, it can mimic other dermatoses such as leishmaniasis or tuberculosis. Despite the rarity of this infection, clinicians should suspect it in patients with chronic skin lesions (verrucous, vegetative, nodular and grouped in patches), especially if they occur in areas exposed to potential plant injuries, such as the lower limbs. Mycological examination is necessary to confirm the diagnosis. Surgery or the association between surgery and systemic antifungal drugs are the treatments of choice because antifungal drugs alone may result in resistances or recurrences.
我们报告了一名来自农村地区的13岁女性患者的病例,该患者右下肢下三分之一处出现4/3厘米的丘疹结节性病变,在过去两年中不断发展。皮肤活检显示乳头瘤样增生伴嗜中性微脓肿和孢子。直接真菌学检查显示烟曲霉样体,培养分离出裴氏着色真菌。患者接受了药物手术治疗(特比萘芬250毫克/天,持续6个月+切除,然后进行皮肤移植),病情进展良好,随访2年无复发。着色芽生菌病是一种慢性真菌性皮肤感染,常见于热带和亚热带地区,在北非罕见。在摩洛哥,截至2014年6月,文献中仅报道了7例。它是在接触土壤或有机物后因接种病菌而感染。致病病原体是属于暗色孢科的色素真菌。鉴于其罕见性,它可能会模仿其他皮肤病,如利什曼病或结核病。尽管这种感染罕见,但临床医生对慢性皮肤病变(疣状、增殖性、结节性且成簇成片)的患者应怀疑有此病,尤其是病变发生在可能受到植物损伤的部位,如下肢。真菌学检查对于确诊是必要的。手术或手术与全身抗真菌药物联合是首选治疗方法,因为单独使用抗真菌药物可能会导致耐药或复发。