摘要患者男,52岁.鼻背部红斑并皮下结节,软腭溃烂,偶有疼痛并伴鼻出血3年余,左眼眶下出现0.8 cm×0.4 cm大小结节1月余.患者曾接受伊曲康唑、氟康唑等抗真菌药物治疗,无满意疗效.患者一般情况好,既往有肺结核病史,T淋巴细胞亚群示CD3减少.皮损组织病理检查示真皮中下层有炎细胞及多核巨细胞浸润,HE和PAS染色见粗大较短的无隔菌丝.经真菌培养及分子生物学鉴定为多变根毛霉.该临床分离株在体外对两性霉素B敏感,对伊曲康唑、酮康唑、氟康唑均耐药.经两性霉素B治疗6周后,患者皮损明显消退,两性霉素B总用量为821 mg.治疗结束后,手术活检取鼻背部及软腭组织做真菌培养和组织病理检查.组织病理中炎性细胞明显减少,未发现菌丝.26℃、32℃(±3℃)中恒温培养3周均未见真菌生长.据此,该患者已达到临床、组织病理学和真菌学治愈.治疗期间自觉食欲差,有药物性肾功能异常、一过性低血钾.

abstractsA 52-year-old man presented with a subcutaneous tubercle and erytbema on the nasal dorsum as well as ulcerated soft palate, and suffered from nasal hemorrhage for 3 years.About 1 month prior to the presentation, a tubercle sized 0.8 cm× 0.4 cm developed under the left fossa orbitalis.He had ever received treatment with antifungal drugs such as itraeonazole and fluconazole, however, the effectiveness was unsatisfactory.He had been in good health with the exception of a past history of pulmonary tuberculosis.The proportion of CD3+ T ceils was decreased.Histopathology of the cutaneous lesion showed lots of inflammatory cells and multinucleated giant cells infiltrating in the mid-dermis and sub-dermis.Hematoxylin-eosin and PAS staining revealed the presence of some grossus and aseptate hyphae.The clinical isolate was identified as Rhizomucor variabilis by culture and molecular biology, and the case was diagnosed as primary cutaneous mueormyeosis.Susceptibility test disclosed that the clinical strain was sensitive to amphotericin B, but resistant to itraconazole, ketoconazole and fluconazole in vitro.After 6-week treatment with oral amphoteriein B(total dose, 821 mg),the lesion obviously subsided; the biopsy tissue from the nasal dorsum and soft palate was subjected to second histopathology which revealed a decrease in the number of inflammatory cells and absonee of hyphae, and the fungal culture of biopsy tissue at 26 ℃ and 32℃(± 3 ℃)for 3 weeks was negative.Finally, the patient achieved a clinical, histopathological and mycological cure.During the treatment course, he experienced poor appetite, drug-induced impairment of renal function and transient kaliopenia.