Schwartz R A, Lamberts R J
J Am Acad Dermatol. 1981 Jan;4(1):38-46. doi: 10.1016/s0190-9622(81)70005-7.
Cutaneous manifestations of coccidioidomycosis may be divided into primary and secondary lesions. Since such lesions may be the only evidence of infection, the distinction is important. Primary (inoculation) lesions are rare. Secondary lesions develop from primary pulmonary disease, commonly. An isolated nodule on the scalp was the presenting sign of disseminated coccidioidomycosis in our patient. Because of the rarity of primary cutaneous coccidioidomycosis, cutaneous lesions due to it should alert the physician to the presence of disseminated disease. The clinical spectrum of such lesions is wide. Our patient was an elderly man with a hyperkeratotic scalp nodule clinically felt to be an actinic keratosis or an early squamous cell carcinoma. We suggest that patients with a travel or resident history in endemic areas be viewed with a high index of suspicion for skin lesions of cutaneous coccidioidomycosis. The advent of orally administered imidazole antifungal agents makes early and aggressive diagnosis of these lesions even more important.
球孢子菌病的皮肤表现可分为原发性和继发性损害。由于这些损害可能是感染的唯一证据，因此这种区分很重要。原发性（接种性）损害很少见。继发性损害通常由原发性肺部疾病发展而来。我们的患者头皮上孤立的结节是播散性球孢子菌病的首发症状。由于原发性皮肤球孢子菌病罕见，因此由其引起的皮肤损害应提醒医生注意播散性疾病的存在。此类损害的临床谱很广。我们的患者是一位老年男性，头皮有角化过度性结节，临床上认为是光化性角化病或早期鳞状细胞癌。我们建议，对于有流行地区旅行或居住史的患者，应高度怀疑其患有皮肤球孢子菌病的皮肤损害。口服咪唑类抗真菌药物的出现使得对这些损害进行早期积极诊断变得更加重要。
