深在性皮膚カンジダ症—カンジダ性膿瘍の1例

A CASE OF CANDIDA ABSCESS

　近年抗生物質や副腎皮質ホルモン剤が普及するようになつてから，内科領域では内臓カンジダ症が増加し，皮膚科領域では皮膚カンジダ症の病型に変化が生じていることが指摘されるようになつた^1）。しかし，深在性皮膚カンジダ症はやはりまれな疾患で，日本語文献での報告は10例に満たないのである。著者らは深在性皮膚カンジダ症とみなしうる単発性のカンジダ性膿瘍の1例を経験したので，症例を報告するとともに，本症の発生機序について若干の卑見を述べる。

A 21-year-old Japanese woman had been troubled with itchy scaling eruptions on the pubic region, groin and genitalia for the past 3 months. The lesions were treated topically with corticosteroid by gynecologist. The lesions, however, gradually exacerbated and her body weight was decreased about 10 kg, over the period. On March 31, 1969, she visited our clinic. Large numbers of fungi were found in the scales taken from the groin. Urinalysis showed glucosuria. Fasting blood sugar was 255mg/dl. The diagnosis of cutaneous and vaginal candidiasis with diabetes mellitus were made. Trichomycin was topically applied to lesions of superficial cutaneous and vaginal candidiasis for 10 days. When the superficial lesions were improved, a cutaneous nodule of 1×1cm. in diameter was found at the left major labium. The nodule was excised and submitted for histologic and fungal examination. Fungi were isolated from the cut surface of nodule and identified as candida albicans. A pronounced granulomatous infiltrate is present in the dermis. The center of the lesion showed abscess formation. The infiltrate was composed of neutrophils, histiocytes, plasma cells, lymphocytes, eosinophils and some numbers of foreignbody giant cells. Massive oval round spores and several pseudohyphae were detected in the dermis with PAS stain. On the basis of the above mentioned data, the diagnosis of "Candida abscess" was made. Candida abscess is a kind of deep cutaneous candidiasis and extremely rare disease.

In the presented case, superficial candidiasis was followed by candida abscess, probably indu ced by a topical application of corticosteroid. There are some reports of deep cutanceous candidiasis, although it is a common habitude of candida not to invade living tissues. In these cases, candida was introduced to the dermis from the skin surface, directly by trauma or indirectly by other causes. The presented case is considered to have occurred following ruptured folliculitis.