Voloshin D K, Lacomis D, McMahon D
Department of Medicine (Division of Infectious Diseases), University of Pittsburgh, PA 15261, USA.
Muscle Nerve. 1995 May;18(5):531-5. doi: 10.1002/mus.880180509.
A 54-year-old man with dermatomyositis initially responsive to corticosteroids and methotrexate developed severe myalgias, increasing weakness, and fevers. Laboratory studies were suggestive of disseminated histoplasmosis, and muscle biopsy revealed myositis, fasciitis, and yeast in the perimysial connective tissue. Histoplasma capsulatum was cultured from skeletal muscle. Despite antifungal therapy, necrotizing fasciitis progressed to gluteal abscess formation. Disseminated histoplasmosis may present atypically in immunocompromised hosts as fasciitis and myositis. Patients with dermatomyositis could be particularly vulnerable to soft tissue invasion by fungi due to their underlying microangiopathy.
一名54岁的皮肌炎男性患者，最初对皮质类固醇和甲氨蝶呤有反应，后来出现严重肌痛、肌无力加重和发热。实验室检查提示播散性组织胞浆菌病，肌肉活检显示肌炎、筋膜炎，肌周结缔组织中有酵母菌。从骨骼肌中培养出荚膜组织胞浆菌。尽管进行了抗真菌治疗，坏死性筋膜炎仍进展为臀肌脓肿形成。播散性组织胞浆菌病在免疫功能低下的宿主中可能表现为非典型的筋膜炎和肌炎。皮肌炎患者由于其潜在的微血管病变，可能特别容易受到真菌对软组织的侵袭。
