红色毛癣菌自体接种致免疫正常患者Majocchi's肉芽肿1例及文献复习

摘要/Abstract

摘要：

目的通过报告1例Majocchi's肉芽肿病例及文献复习，进一步了解Majocchi's肉芽肿的临床特征，为诊治Majocchi's肉芽肿提供思路。方法报告1例红色毛癣菌自体接种致面部Majocchi's肉芽肿，并对既往文献进行复习，总结免疫正常患者Majocchi's肉芽肿的临床特点。结果共检索到Majocchi's肉芽肿病例报告及相关文献58篇，与本例病例共计71例患者，其中免疫功能正常患者35例，占49.3%，男性24例，女性11例；总结了35例免疫功能正常患者Majocchi's肉芽肿临床及微生物学特征，根据病史，患者初次就诊误诊率达57.1%（20/35）。治疗推荐采用系统性抗真菌药物。结论全面认真的体格检查、确定基本皮疹性质、采集详细病史及接触史等可以为皮肤科医生提供诊断线索，真菌镜检及培养是重要的诊断的依据。

关键词: Majocchi's肉芽肿, 红色毛癣菌, 自体接种

Abstract:

Objective To report a case of Majocchi's granuloma due to autoinoculation and review related literatures to provide ideas for diagnosis and treatment of Majocchi's granuloma. Method A case of Majocchi's granuloma on face was due to autoinoculation of Trichophyton rubrum. Clinical characters of Majocchi's granulomain immunocompetent patients were also reviewed. Results Totally there were 58 published papers including case reports and related articles were enrolled. Among71 cases, there were 35 immunocompetent patients including 24 males and 11 females. The clinical characters of the 35 immunocompetent patients were summarized. The initial misdiagnosis rate during the first clinic visit was 57.1% (20/35). Systemic antifungal drugs were the first choice for treatment. Conclusion Comprehensive and careful physical examination, confirmation of basic skin lesion and collection of detailed medical history could provide important clues for accurate diagnosis.

Key words: Majocchi's granuloma, autoinoculation, Trichophyton rubrum

中图分类号:

R379.2

赵颖, 李莉, 陈连军, 朱均昊, 章强强. 红色毛癣菌自体接种致免疫正常患者Majocchi's肉芽肿1例及文献复习[J]. 中国真菌学杂志, 2019, 14(4): 210-216.

ZHAOYing, LI Li, CHEN Lian-jun, ZHU Jun-hao, ZHANG Qiang-qiang. Majocchi's granuloma due to autoinoculation of Trichophyton rubrum and review of literature[J]. Chinese Journal of Mycology, 2019, 14(4): 210-216.

参考文献

[1] Gupta G, Burden AD, Roberts DT. Acute suppurative ringworm (kerion) caused by Trichophyton rubrum[J]. Br J Dermatol, 1999,140(2):369-370.
[2] Nir-Paz R, Elinav H, Pierard GE, et al. Deep Infection by Trichophyton rubrum in an immunocompromised patient[J]. J Clin Microbiol,2003, 41(11):5298-5301.
[3] Kershenovich R, Sherman S, Reiter O, et al. A Unique clinicopathological manifestation of fungal infection:a case series of deep dermatophytosis in immunosuppressed patients[J]. Am J Clin Dermatol, 2017, 18(5):697-704.
[4] Gupta AK,Prussick R, Sibbald RG, et al. Terbinafine in the treatment of Majocchi's granuloma[J]. Int J Dermatol, 1995, 34(7):489.
[5] Margolis DJ, Weinberg JM,Tangoren IA, et al. Trichophytic granuloma of the vulva[J]. Dermatology,1998, 197(1):69-70.
[6] Gupta AK,Groen K, Woestenborghs R, et al. Itraconazole pulse therapy is effective in the treatment of Majocchi's granuloma:a clinical and pharmacokinetic evaluation and implications for possible effectiveness in tinea capitis[J]. Clin Exp Dermatol, 1998, 23(3):103-108.
[7] Erbagci Z. Deep dermatophytoses in association with atopy and diabetes mellitus:Majocchi's granuloma tricophyticum or dermatophytic pseudomycetoma[J]? Mycopathologia, 2002, 154(4):163-169.
[8] Chen HH, Chiu HC. Facial Majocchi's granuloma caused by Trichophyton tonsurans in an immunocompetent patient[J]. Acta Derm Venereol. 2003, 83(1):65-66.
[9] Tateishi Y, Sato H, Akiyama M, et al. Severe generalized deep dermatophytosis due to Trichophyton rubrum (trichophyticgranuloma) in a patient with atopic dermatitis[J]. Arch Dermatol, 2004, 140(5):624-625.
[10] Chang SE, Lee DK, Choi JH, et al.Majocchi's granuloma of the vulva caused by Trichophyton mentagrophytes[J]. Mycoses, 2005, 48(6):382-384.
[11] Feng WW, Chen HC, Chen HC.Majocchi's granuloma in a 3-year-old boy[J]. Pediatr Infect Dis J, 2006, 25(7):658-659.
[12] Cho HR, Lee MH, Haw CR.Majocchi's granuloma of the scrotum[J]. Mycoses, 2007, 50(6):520-522.
[13] Gill M, Sachdeva B, Gill PS, et al. Majocchi's granuloma of the face in an immunocompetent patient[J]. J Dermatol, 2007, 34(10):702-704.
[14] Ratajczak-Stefanska V, Kiedrowicz M, Maleszka R, et al. Majocchi's granuloma caused by Microsporum canis in an immunocompetent patient[J]. Clin Exp Dermatol, 2010, 35(4):445-447.
[15] Bae BG, Kim HJ,Ryu DJ, et al. Majocchi granuloma caused by Microsporum canis as tinea incognito[J]. Mycoses, 2011, 54(4):361-362.
[16] Kurian A, Haber RM. Tinea corporis gladiatorum presenting as a Majocchi granuloma[J]. ISRN Dermatol, 2011, 2011:767589.
[17] Bressan AL, Silva RS, Fonseca JC, et al. Majocchi's granuloma[J]. An Bras Dermatol, 2011, 86(4):797-798.
[18] Collins MA, Lloyd R. Photo quiz. Treatment-resistant plaque on the thigh.Majocchi granuloma[J]. Am Fam Physician, 2011, 83(6):753-754.
[19] Liu C,Landeck L, Cai SQ, et al. Majocchi's granuloma over the face[J]. Indian J Dermatol Venereol Leprol, 2012,78(1):113-114.
[20] Pietrzak A, Tomasiewicz K, Kanitakis J, et al. Trichophyton mentagrophytes-associated Majocchi's granuloma treated with cryotherapy[J]. Folia Histochem Cytobiol, 2012, 50(3):486-489.
[21] Ilkit M, Durdu M, Karakas M. Majocchi's granuloma:a symptom complex caused by fungal pathogens[J]. Med Mycol, 2012, 50(5):449-457.
[22] Li FQ, Lv S, Xia JX. Majocchi's granuloma after topical corticosteroids therapy[J]. Case Rep Dermatol Med, 2014, 2014:507176.
[23] Kanaan IC, Santos TB,Kac BK, et al. Majocchi's granuloma-case report[J]. An Bras Dermatol, 2015, 90(2):251-253.
[24] Liu HB, Liu F, Kong QT, et al. Successful treatment of refractory Majocchi's granuloma with voriconazole and review of published literature[J]. Mycopathologia, 2015, 180(3-4):237-243.
[25] Rallis E, Katoulis A, Rigopoulos D. Pubic Majocchi's granuloma unresponsive to itraconazole successfully treated with oral terbinafine[J]. Skin Appendage Disord, 2016, 1(3):111-113.
[26] Wargo JJ, Berg A, Gudjonsson JE. Ongoing pleuritic chest pain and a guinea pig:missed pulmonary embolism and Majocchi's granuloma[J]. Am J Med, 2016, 129(9):e165-167.
[27] Su HL, Li L, Cheng BL, et al. Trichophyton rubrum infection characterized by Majocchi's granuloma and deeper dermatophytosis:case report and review of published literature[J]. Mycopathologia, 2017, 182(5-6):549-554.
[28] Parmar NV, Asir GJ,Rudramurthy SM. Atypical presentation of Majocchi's granuloma in an immunocompetent host[J]. Am J Trop Med Hyg, 2017, 96(1):1-2.
[29] Gallo JG, Woods M, Graham RM, et al. A severe transmissible Majocchi's granuloma in an immunocompetentreturned traveler[J]. Med Mycol Case Rep, 2017, 18:5-7.
[30] Wang XX, Yang Y, Li RY, et al. Two cases of dermatophytic granuloma successfully treated with terbinafine[J]. Mycopathologia, 2017, 183(3):611-614.
[31] 宋琳毅,王洪生,刘训荃,等. 播散型红色毛癣菌肉芽肿5例[J]. 中国麻风皮肤病杂志,2006,22(6):467-469.
[32] Szepietowski JC, Matusiak L. Trichophyton rubrum autoinoculation from infected nails is not such a rare phenomenon[J]. Mycoses,2008,51:345-346.
[33] Pineiro L, Larruskain J, Idigoras P, et al. Trichophyton rubrum syndrome:the tip of the iceberg and a preventable outcome[J]. Mycoses,2010,53(2):186.