Verma Shikha, Thakur Binod Kumar, Raphael Vandana, Thappa Devinder Mohan
Department of Dermatology and STD, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India.
Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India.
Indian J Dermatol. 2018 Nov-Dec;63(6):496-501. doi: 10.4103/ijd.IJD_16_18.
Subcutaneous mycoses, although rare, are frequently reported from northeast India. Their spectrum varies with geographic region.
We evaluated clinical records and histopathological features of subcutaneous mycoses cases seen during April 2013 to March 2017.
A total of 70 patients (44 males and 26 females) of subcutaneous mycoses were analyzed. Sixty-one percent of patients were 20-60 years old. Duration of the disease ranged from 3 months to 25 years. Most common site of involvement was the lower limb (32, 46%), followed by the upper limb (25, 36%). A history of trauma was obtained from 76% of patients. Eighty-seven percent of patients were from rural area. Ninety-two percent of patients were agricultural workers. There were 30 established cases of chromoblastomycosis and 16 cases of sporotrichosis. In 24 cases, subcutaneous mycosis was suspected clinically and showed some improvement to empirical itraconazole therapy. Multifocal lesions were seen in six patients. Complication of subcutaneous mycoses in the form of invasive squamous cell carcinoma was seen in one patient. On histopathological examination, verrucous hyperplasia was seen in 93% of cases. Granulomas with suppuration were seen in 77% of cases and granulomas without suppuration were seen in 14.3% of cases. Copper penny bodies were appreciated in 42.8% of cases. Fungal culture was positive only in 55.7% of cases. There was growth of in 16 patients, sp. in 19, sp. in 3, and sp. in 1.
Chromoblastomycosis was the most common subcutaneous mycoses seen in northeast India followed by sporotrichosis. The diagnosis remained a challenge in a few cases as the culture positivity was very low. Suppurative granulomas in histopathology played a corroborative role. Therapeutic trial of itraconazole for 2 months was worth trying in such cases.
皮下真菌病虽罕见，但在印度东北部常有报道。其病种因地理区域而异。
我们评估了2013年4月至2017年3月期间皮下真菌病病例的临床记录和组织病理学特征。
共分析了70例皮下真菌病患者（44例男性和26例女性）。61%的患者年龄在20至60岁之间。病程从3个月到25年不等。最常见的受累部位是下肢（32例，46%），其次是上肢（25例，36%）。76%的患者有外伤史。87%的患者来自农村地区。92%的患者为农业工人。有30例确诊的着色芽生菌病病例和16例孢子丝菌病病例。24例临床上怀疑为皮下真菌病，经经验性伊曲康唑治疗后有一定改善。6例患者出现多灶性病变。1例患者出现侵袭性鳞状细胞癌形式的皮下真菌病并发症。组织病理学检查显示，93%的病例有疣状增生。77%的病例有化脓性肉芽肿，14.3%的病例有无化脓性肉芽肿。42.8%的病例可见铜便士体。真菌培养仅在55.7%的病例中呈阳性。16例患者培养出 ，19例培养出 菌，3例培养出 菌，1例培养出 菌。
在印度东北部，着色芽生菌病是最常见的皮下真菌病，其次是孢子丝菌病。由于培养阳性率很低，少数病例的诊断仍然是一项挑战。组织病理学中的化脓性肉芽肿起到了佐证作用。在这类病例中，伊曲康唑2个月的治疗性试验值得一试。
