Machet M C, Stephanov E, Estève E, De Closets F, Barrabès A, Thérizol-Ferly M, Lebret G, Grangeponte M C, Vaillant L
Service d'Anatomie pathologique, CHU Trousseau, Tours.
Ann Pathol. 1994;14(3):186-91.
Alternaria is a very common fungus. Its pathogenic role in human pathology is mainly expressed by asthma. Cutaneous infection is rare and only about 70 cases have been described. Because of its wide distribution in the environment, cutaneous biopsy is necessary to ensure the diagnosis. We report two cases of dermal alternariosis occurring in the course of pemphigus treated with immunosuppressive therapy. Histological examination revealed a hyperplasic epidermis. The upper dermis showed a mixed inflammatory infiltrate with neutrophils, histiocytes and giant cells. Round intracytoplasmic inclusions staining faintly with PAS wer seen in giant cells. Long intercellular filaments were present in the infiltrate. This histopathological aspect is not specific, and cultures of both cutaneous biopsies were necessary. The association of dermal alternariosis and pemphigus is explained both by the immunosuppressive therapy for pemphigus and by the cutaneous fragility induced by the acantholytic disease permitting direct inoculation of Alternaria.
链格孢属是一种非常常见的真菌。它在人类病理学中的致病作用主要表现为引发哮喘。皮肤感染较为罕见，仅有约70例相关病例被描述。由于其在环境中广泛分布，因此需要进行皮肤活检以确保诊断。我们报告了两例在接受免疫抑制治疗的天疱疮病程中发生的皮肤链格孢病病例。组织学检查显示表皮增生。真皮上层可见中性粒细胞、组织细胞和巨细胞混合性炎症浸润。在巨细胞中可见圆形胞质内包涵体，对PAS染色呈淡染。浸润中存在长的细胞间细丝。这种组织病理学表现并不具有特异性，因此对两份皮肤活检标本均进行培养是必要的。皮肤链格孢病与天疱疮的关联可通过天疱疮的免疫抑制治疗以及棘层松解性疾病所致的皮肤脆弱性来解释，后者使得链格孢能够直接接种。
