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NEJM：播散性皮肤芽生菌病-病例报道

2018-07-05 xing.T MedSci原创

播散性皮肤芽生菌病
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Grocott乌洛托品银染色和粘蛋白染色证实了播散性皮肤芽生菌病的诊断，即皮肤芽孢杆菌引起的真菌感染。患者可能出现原发性肺部感染或经血液传播到皮肤、骨骼、泌尿生殖道或中枢神经系统的疾病。

患者为一名44岁的男性，因身上有非瘙痒性皮肤病变，包括面部、胸部、背部、手臂和腿部，而到皮肤科门诊就诊。六个月前，该患者出现发热、咳嗽和呕吐1周。随后，身上出现多个结节。他从事建筑工作，并报告最近没有旅行、接触宠物或与病人接触史。

体格检查发现许多散在结痂的结节和已经形成了紫红色边界的斑块（如图所示）。肺部听诊清晰，没有明显的淋巴结肿大。胸部的X光片未显示浸润病变。全血细胞计数正常，人体免疫缺陷病毒感染和梅毒检测均为阴性。皮肤组织的真菌培养呈阴性；然而，皮肤活检显示假性上皮瘤样增生，表皮内中性脓肿，以及具有广泛出芽的圆形酵母。



Grocott乌洛托品银染色和粘蛋白染色证实了播散性皮肤芽生菌病的诊断，即皮肤芽孢杆菌引起的真菌感染。患者可能出现原发性肺部感染或经血液传播到皮肤、骨骼、泌尿生殖道或中枢神经系统的疾病。

该患者接受伊曲康唑治疗6个月；在就诊后6周的随访中观察到皮肤病变显著改善。

原始出处：

Barry Ladizinski,et al.Disseminated Cutaneous Blastomycosis. N Engl J Med 2018; https://www.nejm.org/doi/full/10.1056/NEJMicm1706

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    2018-07-30 clmlylxy

    #播散性#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1769419, encodeId=70051e69419aa, content=<a href='/topic/show?id=3ca75e0059d' target=_blank style='color:#2F92EE;'>#播散性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57005, encryptionId=3ca75e0059d, topicName=播散性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c90838047642, createdName=clmlylxy, createdTime=Mon Jul 30 12:53:00 CST 2018, time=2018-07-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=330180, encodeId=ea4b33018057, content=学习了.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/07/01/f44914be7c8d63065aa79516f6c8ab42.jpg, createdBy=f3d12281495, createdName=许珊珊XS10, createdTime=Sun Jul 08 15:59:03 CST 2018, time=2018-07-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=329461, encodeId=5db132946103, content=学习了.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Thu Jul 05 08:54:01 CST 2018, time=2018-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=329454, encodeId=03e6329454e7, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu Jul 05 08:40:01 CST 2018, time=2018-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=329442, encodeId=12223294421b, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Thu Jul 05 08:19:12 CST 2018, time=2018-07-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=329441, encodeId=48633294416c, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Thu Jul 05 08:19:10 CST 2018, time=2018-07-05, status=1, ipAttribution=)]
    2018-07-08 许珊珊XS10

    学习了.谢谢分享

    0

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    2018-07-05 1ddf0692m34(暂无匿称)

    学习了.谢谢分享

    0

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    2018-07-05 龙胆草

    学习谢谢分享

    0

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    2018-07-05 哈哈869

    学了

    0

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    2018-07-05 哈哈869

    学了

    0