Lemerle E, Bastien M, Demolliens-Dreux G, Forest J L, Boyer E, Chabasse D, Célérier P
Service de Dermatologie-Vénéréologie, C.H. Le Mans.
Ann Dermatol Venereol. 1998 Oct;125(10):711-4.
Non-mycetomatous cutaneous scedosprium is an uncommon mycosis observed in immunodepressed subjects. We report a case with an inaugural presentation of bullous and necrotic purpura.
A 79-year-old man on intermittent corticosteroid therapy for bronchospasm was admitted for bullous and necrotic purpura and fever. Subcutaneous nodules with a sporotrichoid aspect developed despite wide-spectrum antibiotics. Microbiology samples cultured on Sabouraud medium evidenced Scedosporium apiospermum. The pathogenic nature of the infection was proven on a skin biopsy showing numerous myceleal filaments with Gomori-Grocott staining despite negative PAS. No pulmonary involvement was evidenced. The patient was treated unsuccessfully with itraconazole. A Pseudomonas lung infection was fatal.
Scedosporium apiospermum, an ubiquitous ascomycetes anamorphous to Pseudallescheria boydii, is the cause of a growing number of human infections due to widespread use of immunosuppressors. Skin and lung localizations predominate. The inaugural bullous and necrotic purpural skin manifestations in this case are unusual. In addition, the patient was only minimally immunodepressed and despite demonstrated in vitro sensitivity, itraconazole was ineffective clinically. Treatment is not well defined, but surgery is essential in combination with empirically chosen antifungals.
非足菌肿性皮肤弯孢霉病是一种在免疫抑制患者中观察到的罕见真菌病。我们报告一例以大疱性和坏死性紫癜为首发表现的病例。
一名79岁男性，因支气管痉挛接受间歇性皮质类固醇治疗，因大疱性和坏死性紫癜及发热入院。尽管使用了广谱抗生素，但仍出现了具有孢子丝菌病样外观的皮下结节。在沙氏培养基上培养的微生物样本证实为尖端赛多孢菌。皮肤活检显示尽管PAS染色阴性，但经戈莫里-格罗科特染色可见大量菌丝丝，从而证实了感染的致病性。未发现肺部受累。患者接受伊曲康唑治疗无效。一次铜绿假单胞菌肺部感染是致命的。
尖端赛多孢菌是一种无处不在的子囊菌，无性型为博伊德假阿利什菌，由于免疫抑制剂的广泛使用，导致人类感染的病例越来越多。皮肤和肺部感染最为常见。该病例中首发的大疱性和坏死性紫癜皮肤表现并不常见。此外，该患者仅有轻微免疫抑制，尽管体外试验显示敏感，但伊曲康唑临床治疗无效。治疗方法尚不明确，但手术结合经验性选择的抗真菌药物是必不可少的。
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