Verret J L, Gaborieau F, Chabasse D, Rohmer V, Avenel M, Smulevici A
Ann Dermatol Venereol. 1982;109(10):841-6.
This case concerned a 67 old farmer who presented a vegetating and crusted tumor of the right knee. Histological examination revealed intracellular round structures PAS + within an inflammatory dermal granuloma, including epithelioid and giant cells. Alternaria could be isolated on cultures from biopsies of the tumor. Ultrastructural study specifies the morphological aspects of Alternaria within dermal granuloma; furthermore, large numerous myelinic bodies were present within the parasitic cells. The clinical aspect of the patient led to hormonal explorations and a Cushing's disease yet unrecognized was ascertained, that probably represented the "special terrain" which made the growth of Alternaria possible. The survey of the available literature revealed two cases of alternariosis and Cushing's syndrome, but in these two cases the diagnosis of the endocrinopathy was already established when the cutaneous infection developed. The lesion cleared within a month after electrocoagulation, local iodine compound and griseofulvine per os, with nonrelapse 12 months after.
该病例涉及一名67岁的农民，其右膝出现了一个赘生性结痂肿瘤。组织学检查显示，在炎症性真皮肉芽肿内，包括上皮样细胞和巨细胞，存在PAS阳性的细胞内圆形结构。从肿瘤活检组织培养中可分离出链格孢菌。超微结构研究明确了链格孢菌在真皮肉芽肿内的形态学特征；此外，在寄生细胞内存在大量髓样小体。患者的临床症状促使进行了激素检查，结果确诊为尚未被识别的库欣病，这可能代表了使链格孢菌得以生长的“特殊体质”。对现有文献的检索发现了两例链格孢菌病和库欣综合征的病例，但在这两例中，皮肤感染发生时内分泌病的诊断已经确立。经电凝、局部碘化合物和口服灰黄霉素治疗后，病变在一个月内消退，12个月后未复发。
