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一名肾移植患者感染由一种前所未见的暗色丝孢霉引起的着色芽生菌病。

Chromoblastomycosis Due to a Never-before-Seen Dematiaceous Fungus in a Kidney Transplant Patient.

作者信息

Guegan Hélène, Cailleaux Marine, Le Gall François, Robert-Gangneux Florence, Gangneux Jean-Pierre

机构信息

Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, F-35000 Rennes, France.

Infectious Diseases and Intensive Care Unit, CHU Rennes, F-35033 Rennes, France.

出版信息

Microorganisms. 2021 Oct 13;9(10):2139. doi: 10.3390/microorganisms9102139.

Abstract

Chromoblastomycosis is a neglected fungal infection of the epidermis and subcutaneous tissue that predominates in tropical areas and results from the traumatic inoculation of environmental dematiaceous filamentous fungi. We describe the case of an immunosuppressed patient diagnosed with foot chromoblastomycosis due to an uncommon dematiaceous fungus. A 52-year-old Congolese kidney transplant woman presented with a painful lesion located on the foot. No trauma to the lower limbs was reported during the previous months. She lived in France and had not returned to the Congo over the previous eight years. Histology and mycological examination from skin biopsy revealed swollen dark filaments associated with dematiaceous muriform cells, pathognomonic of chromoblastomycosis. Cultures grew with dark pigmented colonies, yielding poor microscopic features. The phylogenetic analysis confirmed that the isolate was a member of Kirschsteiniotheliales (Dothideomycetes) and unrelated to the Chaetotyriales, of which most species commonly responsible for chromoblastomycosis belong. As there was no bone spreading, excision surgery of the entire lesion followed by liposomal amphotericin B therapy resulted in complete healing after six months. This original case illustrates the potential diversity of environmental dematiaceous fungi responsible for phaeohyphomycosis, especially chromoblastomycosis, and the need to send samples to mycology labs for appropriate diagnosis.

摘要

着色芽生菌病是一种被忽视的表皮和皮下组织真菌感染,主要发生在热带地区,由环境中暗色丝状真菌的创伤性接种引起。我们描述了一例免疫抑制患者因一种罕见的暗色真菌被诊断为足部着色芽生菌病的病例。一名52岁的刚果肾移植女性患者足部出现疼痛性病变。前几个月未报告下肢有外伤史。她生活在法国,过去八年未回过刚果。皮肤活检的组织学和真菌学检查显示有肿胀的深色细丝,伴有暗色砖形细胞,这是着色芽生菌病的特征性表现。培养长出深色色素菌落,显微镜下特征不佳。系统发育分析证实该分离株是基尔施泰内皮菌目(座囊菌纲)的成员,与大多数通常导致着色芽生菌病的毛壳菌目无关。由于没有骨扩散,对整个病变进行切除手术,随后进行脂质体两性霉素B治疗,六个月后完全愈合。这个独特的病例说明了导致暗色丝孢霉病,尤其是着色芽生菌病的环境暗色真菌的潜在多样性,以及将样本送到真菌学实验室进行恰当诊断的必要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5b7a/8536985/0dce2e842b4a/microorganisms-09-02139-g001.jpg

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