Machet L, Jan V, Machet M C, Vaillant L, Lorette G
Service de dermatologie, CHU Trousseau, Tours, France.
Dermatology. 1996;193(4):342-4. doi: 10.1159/000246287.
Alternaria is a very common and saprophytic fungus. Cutaneous infection is rare and about 71 cases have been described, mainly in Europe in immunocompromised hosts. We report a case of dermal alternariosis occurring in a woman treated with corticosteroids for dermatomyositis. The cutaneous lesion consisted of an erythematous and scaly plaque on the leg measuring 2 x 2 cm. Cutaneous biopsy showed hyphae and round inclusions stained with PAS and Gomori-Grocott within a polymorphous granuloma. Cultures of cutaneous biopsies grew Alternaria sp. HIV1 and HIV2 serology was negative. The patient was treated by local excision and corticosteroids were decreased. One-year follow-up showed no recurrence. Cutaneous alternariosis is an opportunistic infection. the disease has been described mainly in patients treated with systemic corticosteroids (39 cases out of the 71 reported cases) or local corticosteroids (3/71) and in patients suffering from Cushing's syndrome (7/71) but rarely in HIV-infected patients (3/71). Cutaneous fragility induced by hypercorticism is an important cofactor permitting direct inoculation from the environment.
链格孢是一种非常常见的腐生真菌。皮肤感染罕见，约有71例相关病例报道，主要发生在欧洲的免疫功能低下宿主中。我们报告一例皮真菌病，发生在一名因皮肌炎接受皮质类固醇治疗的女性身上。皮肤损害为腿部一处2×2厘米的红斑鳞屑性斑块。皮肤活检显示，在多形性肉芽肿内有经PAS和Gomori-Grocott染色的菌丝和圆形包涵体。皮肤活检组织培养长出链格孢属菌种。HIV1和HIV2血清学检测均为阴性。患者接受了局部切除治疗，并减少了皮质类固醇的用量。一年的随访显示无复发。皮肤链格孢病是一种机会性感染。该病主要见于接受全身皮质类固醇治疗的患者（71例报告病例中有39例）或局部皮质类固醇治疗的患者（71例中有3例）以及库欣综合征患者（71例中有7例），但在HIV感染患者中很少见（71例中有3例）。皮质醇增多症引起的皮肤脆弱是一个重要的辅助因素，使得真菌能够从环境中直接接种。
