Department of Dermatology, Teikyo University Mizonokuchi Hospital.
Teikyo University Institute of Medical Mycology (TIMM).
Med Mycol J. 2023;64(2):37-43. doi: 10.3314/mmj.22-00025.
A 64-year-old woman presented with a fist-sized, severely painful lesion with scales, crusts, pustules, erythema with subcutaneous abscess, and hair loss on the left temporal region. Direct microscopic examination revealed a large number of spores around the hair, which indicated ectothrix hair invasion, and some hyphae were also found. Histopathological examination showed significant inflammatory cell infiltration from the dermis to the subcutaneous tissues and into the hair follicles, destruction of the hair follicles with granulomatous reactions, and fungal masses along the hair within the hair follicles. Microsporum canis was identified based on morphological features via culture method and molecular biological analysis of the internal transcribed spacer region DNA sequence. The patient was diagnosed with kerion celsi caused by M. canis. For treatment of kerion celsi, we chose an oral antifungal agent, fosravuconazole (FRVCZ), which has been available since 2018 only in Japan. Clinical symptoms were cured in 12 weeks without scarring. No side effects were observed during oral administration of FRVCZ. The results of our case and several previous reports suggest that FRVCZ is effective in treating various types of dermatomycoses.
一位 64 岁女性左侧颞部出现一个拳头大小、严重疼痛的皮损，伴有鳞屑、结痂、脓疱、红斑、皮下脓肿和脱发。直接显微镜检查发现大量孢子围绕毛发，提示外生毛侵犯，还发现一些菌丝。组织病理学检查显示真皮至皮下组织和毛囊内有明显的炎症细胞浸润，毛囊破坏伴有肉芽肿反应，以及真菌团块沿着毛囊内的毛发。通过培养方法和内部转录间隔区 DNA 序列的分子生物学分析，根据形态特征鉴定为犬小孢子菌。该患者被诊断为犬小孢子菌引起的脓癣。对于脓癣的治疗，我们选择了一种口服抗真菌药物，伏立康唑（FRVCZ），它自 2018 年以来仅在日本上市。在 12 周内临床症状得到治愈，无瘢痕。口服 FRVCZ 期间未观察到不良反应。我们的病例和以前的一些报告结果表明，FRVCZ 治疗各种类型的皮肤真菌感染有效。
