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中国真菌学杂志 2011, Vol. 6  Issue (4): 207-211.

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播散性隐球菌病1例及其实验研究

冉梦龙, 鲁巧云, 涂平, 万喆, 杨淑霞, 吴艳, 李若瑜, 王爱平   

  1. 北京大学第一医院皮肤性病科, 北京100034
  • 收稿日期:2010-04-19 出版日期:2011-08-28 发布日期:2011-08-28
  • 通讯作者: 王爱平,E-mail:wangap516@163.com E-mail:wangap516@163.com
  • 作者简介:冉梦龙,男(汉族),硕士研究生在读,住院医师.E-mail:rss-47@163.com

A case of disseminated cryptococcosis:clinical and laboratory investigations

RAN Meng-long, LU Qiao-yun, TU Ping, WAN Zhe, YANG Shu-xia, WU Yan, LI Ruo-yu, WANG Ai-ping   

  1. Department of Dermatology & Venereology, First Hospital, Peking University, Beijing 100034
  • Received:2010-04-19 Online:2011-08-28 Published:2011-08-28

摘要: 目的 播散性隐球菌病1例临床及实验研究。方法 患者男,72岁,红皮病1年2个月,口服醋酸泼尼松治疗,双下肢出现结节、溃烂6个月。皮损组织病理、皮损组织真菌培养、尿素酶试验、PCR扩增测序比对明确诊断,同时做胸部及脑部CT。结果 皮损组织病理显示为感染肉芽肿改变,可见大量圆形和椭圆形酵母细胞。皮损组织真菌培养可见酵母样菌落生长,菌株尿素酶试验阳性,ITS区测序比对鉴定为新生隐球菌grubii变种。血清隐球菌荚膜多糖抗原乳胶凝集试验阳性(++++)。胸部CT显示左下肺后基底段空洞性病灶。依据临床及实验室检查确诊为由新生隐球菌grubii变种引起的播散性隐球菌病。给予患者静滴氟康唑400 mg/d治疗2周,之后改口服300 mg/d治疗,3个月后结节性皮损全部消退,胸片显示左肺陈旧性病变,血清隐球菌荚膜多糖抗原乳胶凝集试验阳性(++)。治疗15个月后,血清隐球菌荚膜多糖抗原乳胶凝集试验仍阳性(++)。结论 对该病例的临床和实验室研究为临床明确诊断和治疗提供了依据,确定菌种需要进行分子生物学研究。

关键词: 播散性隐球菌病, 新生隐球菌grubii变种, 氟康唑, 红皮病

Abstract: Objective To report a case of disseminated cryptococcosis with related laboratory investigations.Methods A 72-year-old man was admitted due to erythroderma with multiple nodules and ulcers on the limbs.The diagnosis was confirmed by CT,biopsy,tissue culture,urease test and PCR sequencing anglysis.Results Skin tissue biopsy showed plenty of fungal components.Tissue culture produced yeast-like colony,which was positive in urease test.The strain was identified as Cryptococcus neoformans var.grubii by sequencing of ribosomal internal transcribed spacer region.Specific cryptococcal antigen test of serum showed strong positive result (++++).Chest CT indicated pulmonary cavity in the posterior basal segment of the left lung.The patient was finally diagnosed as disseminated cryptococcosis caused by Cryptococcus neoformans var.grubii.Conclusions Clinical and laboratory studies of this case assisted diagnosis of disseminated cryptococcosis.Microdissection and ITS region sequencing are promising approaches for diagnosis of fungal infections.

Key words: disseminated cryptococcosis, Cryptococcus neoformans var.grubii, fluconazole, erythroderma

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