Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
BMC Infect Dis. 2019 Aug 9;19(1):707. doi: 10.1186/s12879-019-4351-2.
Talaromyces marneffei is a thermally dimorphic fungus endemic in south-east Asia. It predominantly occurs in both immunocompromised and immunosuppressed patients and can be fatal if diagnosis and treatment are delayed. The clinical manifestations of T. marneffei infection are nonspecific and rapid diagnosis of T. marneffei infection remains challenging.
A 24-year-old man came to our outpatient department with the sign of common skin lesions. The lesions were cuticolor follicular papules with or without central umbilication, nodules and acne-like lesions, which are common in syringoma, steatocystoma multiplex and trichoepithelioma. A dermatoscopy examination was performed to differentiate these skin lesions. The dermatoscopic images revealed circular or quasi-circular whitish amorphous structure with a central brownish keratin plug, providing the diagnostic clues of T. marneffei infection. Therefore, a skin scrapings culture, skin biopsy and serological detection for human immunodeficiency virus (HIV) were performed. The final diagnosis of this patient was T. marneffei and HIV co-infection.
Rapid diagnosis of T. marneffei infection is clinically challenging since presenting clinical manifestations are nonspecific with significant overlap with other common conditions. This case highlights that dermatoscopy is a promising tool for the rapid diagnosis of T. marneffei infection in patients with nonspecific skin lesions, assisting clinicians to avoid delayed diagnosis or misdiagnosis.
马尔尼菲青霉是一种热双相真菌，流行于东南亚。它主要发生在免疫功能低下和免疫抑制的患者中，如果诊断和治疗延迟，可能是致命的。马尔尼菲青霉感染的临床表现是非特异性的，快速诊断马尔尼菲青霉感染仍然具有挑战性。
一名 24 岁男性因常见皮肤病变来到我院门诊。病变为多色滤泡性丘疹，中央有脐凹或无脐凹，结节和痤疮样病变，常见于汗管瘤、多发性皮脂囊瘤和毛发上皮瘤。进行了皮肤镜检查以区分这些皮肤病变。皮肤镜图像显示圆形或类圆形白色无定形结构，中央有棕色角蛋白栓，提供了马尔尼菲青霉感染的诊断线索。因此，进行了皮肤刮片培养、皮肤活检和人类免疫缺陷病毒（HIV）血清学检测。该患者的最终诊断为马尔尼菲青霉和 HIV 合并感染。
由于临床表现非特异性，与其他常见疾病有很大重叠，因此快速诊断马尔尼菲青霉感染在临床上具有挑战性。本病例强调，皮肤镜是一种有前途的工具，可用于快速诊断具有非特异性皮肤病变的患者的马尔尼菲青霉感染，帮助临床医生避免延迟诊断或误诊。
