Department of Dermatology and Venerology, Peking University First Hospital, Beijing, People's Republic of China.
National Clinical Research Center for Skin and Immune Diseases, Beijing, People's Republic of China.
Emerg Microbes Infect. 2023 Dec;12(1):2208685. doi: 10.1080/22221751.2023.2208685.
Dermatophytic pseudomycetoma is a rare invasive infection, involving both immunocompetent and immunocompromised individuals. Since the discovery of inherited immune disorders such as the impairment of gene, extended dermatophyte infections are mostly ascribed to any of these host factors. This study is to present and explore the potential causes in a fatal dermatophytic pseudomycetoma patient. We present a chronic and deep pseudomycetoma caused by the common dermatophyte which ultimately led to the death of the patient. Mycological examination, genetic studies and host immune responses against fungi were performed to explore the potential factors. The patient had decreased lymphocyte counts with significantly reduced CD4 T cells, although all currently known genetic parameters proved to be normal. Through functional studies, we demonstrated that peripheral blood mononuclear cells from the patient showed severe impairment of adaptive cytokine production upon fungus-specific stimulation, whereas innate immune responses were partially defective. This is, to our knowledge, the first report of fatal dermatophytic pseudomycetoma in a patient with non-HIV CD4 lymphocytopenia, which highlights the importance of screening for immune deficiencies in patients with deep dermatophytosis.
真菌性假真菌瘤是一种罕见的侵袭性感染，涉及免疫功能正常和免疫功能低下的个体。自从发现基因等遗传性免疫紊乱以来，大多数扩展的皮肤癣菌感染归因于这些宿主因素中的任何一种。本研究旨在介绍并探讨一例致命性真菌性假真菌瘤患者的潜在病因。我们报告了一例由常见皮肤癣菌引起的慢性深部假真菌瘤，最终导致患者死亡。进行了真菌学检查、基因研究和宿主对真菌的免疫反应，以探讨潜在的因素。患者的淋巴细胞计数减少，CD4 T 细胞明显减少，尽管所有目前已知的遗传参数均正常。通过功能研究，我们证明该患者的外周血单核细胞在真菌特异性刺激下适应性细胞因子产生严重受损，而固有免疫反应部分受损。据我们所知，这是首例非 HIV 性 CD4 淋巴细胞减少症患者致命性真菌性假真菌瘤的报告，这凸显了对深部皮肤癣菌病患者进行免疫缺陷筛查的重要性。
