ボリコナゾールで治療したExophiala jeanselmeiによる皮下黒色菌糸症

・下肢に巨大な腫瘤を形成した黒色菌糸症を経験した．

・培養形態と遺伝子検査により分離菌をExophiala jeanselmei（E. jeanselmei）と同定した．

・ボリコナゾールによる治療が有効であった．

・過去10年間のExophiala属による黒色菌糸症（phaeohyphomycosis）44例を集計した．

（「症例のポイント」より）

　

Subcutaneous phaeohyphomycosis caused by Exophiala jeanselmei

　

Miyashita, Kanako1）Matsuo, Atsuko2）Johno, Masayoshi2）Noguchi, Hiromitsu3）Hiruma, Masataro4）Ihn, Hironobu1）

1）Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University

2）Division of Dermatology, Kumamoto Shinto Hospital

3）Noguchi Dermatology Clinic

4）Ochanomizu Institute for Medical Mycology and Allergology

　

An 88-year-old man receiving 10 mg of prednisolone daily for polymyalgia rheumatica presented to our hospital with a subcutaneous abscess in the left lower limb. A spindle-shaped mass, measuring 25 cm in long diameter, developed 36 months after he sustained a scratch. Magnetic resonance imaging revealed a subcutaneous multilobular cystic lesion in the subcutis. Direct microscopy of pus revealed hyphae, and histopathological examination showed mixed cell granulomas and brown septate hyphae, leading to a diagnosis of phaeohyphomycosis. On the basis of the morphological features and results of gene analysis, the isolate was identified as Exophiala jeanselmei. The patient was treated with daily administration of 200 mg of voriconazole. The lesion gradually decreased in size, and his β-D-glucan level decreased from 1,890 pg/mL to 925 pg/mL.