人畜共患的外阴马约奇肉芽肿。

Skinmed Pub Date : 2024-03-18 eCollection Date: 2024-01-01
Larissa M Pastore, Camille E Introcaso
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引用次数: 0

摘要

一名 32 岁的健康女性因外阴瘙痒病变就诊,病程 2 个月,小腿病变数周。她接受了局部皮质类固醇激素和静脉注射万古霉素的治疗,但病情没有明显好转。检查发现,耻骨上区和外阴部有数十个滤泡状出血性丘疹(图 1)。小腿上也发现了类似但不太明显的病变。外阴和小腿的活组织检查显示,毛囊炎症浸润包括中性粒细胞、组织细胞和淋巴细胞,毛囊基底层和毛发轴内还有真菌菌丝,与马约奇肉芽肿(MG)一致。革兰氏和 Fite-Faraco 染色、直接免疫荧光和细菌培养均呈阴性。通过对 28s rDNA 的 D1/D2 区域进行序列分析,确定了该毛癣菌。测定了特比萘芬、酮康唑和伊曲康唑的最低抑菌浓度,其中特比萘芬的浓度最低。其他病史显示,在患者开始出现临床表现前不久,她饲养的一只宠物豚鼠出现了疹子和脱毛症状(图 2)。医生给患者开了酮康唑乳膏和特比萘芬,每天 250 毫克,病情几乎立即得到改善。根据临床反应,患者继续使用特比萘芬和酮康唑乳膏 6 个月。在停用所有抗真菌药物 4 个月后,她的皮肤仍然保持清洁。根据患者的培养结果,一位兽医用特比萘芬和咪康唑洗剂成功治疗了她的豚鼠。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Zoonotic Majocchi's Granuloma of the Vulva.

A healthy 32-year-old woman presented to clinic with tender pruritic lesions of 2-month duration at the vulva and lesions for weeks on the shins. She was treated with topical corticosteroids and intravenous vancomycin without significant improvement. On examination, dozens of follicular hemorrhagic papulopustules were detected at the suprapubic area and vulva (Figure 1). Similar but less prominent lesions were observed on the shins as well. Biopsies of the vulva and shin revealed a follicular inflammatory infiltrate of neutrophils, histiocytes, and lymphocytes as well as fungal hyphae within the follicular infundibulum and hair shafts, consistent with Majocchi's granuloma (MG). Gram and Fite-Faraco staining, direct immunofluorescence, and bacterial culture were negative. Tissue culture grew Trichophyton mentagrophytes, which was identified using sequence analysis of the D1/D2 region of the 28s rDNA. Minimum inhibitory concentrations for terbinafine, ketoconazole, and itraconazole were determined, with terbinafine having the lowest concentration. Additional history revealed that shortly prior to commencement of her clinical manifestations, the patient had acquired a pet guinea pig with eruptions and hair loss (Figure 2). The patient was prescribed ketoconazole cream and terbinafine, 250 mg daily, with almost immediate improvement. Based on clinical response, the patient remained on terbinafine and ketoconazole cream for 6 months. Her skin remained clear 4 months after discontinuing all antifungals. Based on the results of patient's culture, a veterinarian treated her guinea pig successfully with systemic terbinafine and miconazole lotion.

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