皮膚病診療 41巻6号 (2019年6月)

  • 文献概要を表示

・Trichophyton benhamiae(T. benhamiae)による体部白癬を経験した.

・膿疱を混じた炎症の強い環状皮疹を左上肢と右大腿部に認めた.

・ペットとしてデグー,モルモット,ミニウサギ,イヌを飼育していたが,いずれもT. benhamiaeは検出できなかった.

・分離菌は同菌のGroup IIに属し,スライドカルチャーで螺旋器官や分生子の形成がなく,菌糸は互いに接合し,網状構造を形成した.

・分離菌の形態学的な同定は不可能で,分子生物学的な検索により初めて菌の同定ができた.

・T. benhamiae(Group II)によるヒト感染例は,本邦において,この報告症例を含めて3例目である.

・テルビナフィン内服およびラノコナゾール軟膏外用で約3週間後に軽快した.

(「症例のポイント」より)

 

A case of tinea corporis by Trichophyton benhamiae(Group II)

 

Yanagihara, Makoto1)Anzawa, Kazushi2)Hanakawa, Hiroyoshi1)Mochizuki, Takashi2)

1)Department of Dermatology, Shinseikai Toyama Hospital

2)Department of Dermatology, Kanazawa Medical University

 

A 22-year-old female university student presented to our hospital with three inflamed annular lesions (2 on left arm, 1 on left thigh)with a 3-week history. Fungus isolated from her lesions grew radially and showed white colored colonies on Sabouraud Dextrose Agar and yellow colored colonies on Potato Dextrose Agar. In slide cultures, hyphae were subhyaline and did not form any microconidia or spirals. The hyphae formed loop- or circuit-like mycelial junctions. Phylogenetic analysis of ITS rDNA sequences in isolated fungi identified the fungus as a clade of T. benhamiae (group II). The lesions healed following 3- week treatment with 125 mg of terminafine hyrocroride and topical lanoconazole ointment.

  • 文献概要を表示

・副腎皮質ステロイド外用薬を長期間使用後に生じた前腕の生毛部急性深在性白癬を経験した.

・病理組織学的に真皮内に破壊された毛包とその周囲に膿瘍,肉芽腫を認めた.また膿瘍内にごく少数の菌要素を認めた.

・皮膚組織から培養されたコロニーを分子生物学的に検索した結果,Trichophyton interdigitale(T. interdigitale)と同定した.

・テルビナフィン塩酸塩内服にて治癒した.

(「症例のポイント」より)

 

Tinea corporis on the forearm caused by Trichophyton interdigitale

 

Kimura, Ryoko1)Yamada, Nanako1)Ito, Ayako1)Anzawa, Kazushi2)Mochizuki, Takashi2)Yamamoto, Osamu1)

1)Division of Dermatology, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, Tottori University

2)Department of Dermatology, Kanazawa Medical University

 

A 71-year-old Japanese man had been receiving topical corticosteroid treatment for erythroderma for the past 5 years. He presented with a 1-week history of small, light-yellow nodules on his right forearm. Histopathological examination showed destruction of hair follicles and perifollicular mixed-cellular inflammatory infiltration with granulomatous foci in the dermis. Grocott stain revealed only a few hyphae in the dermis. The isolate was identified as Trichophyton interdigitale by sequence analysis of the internal transcribed spacer regions of the ribosomal RNA gene. The skin lesions disappeared with oral administration of terbinafine of 125 mg daily for 3 weeks.

  • 文献概要を表示

・右拇趾の爪甲色素線条を呈した爪白癬を報告した.

・臨床的に爪部の色素性母斑やBowen病,悪性黒色腫などと鑑別を要した.

・ダーモスコピー所見とKOH検査,真菌培養検査によりTrichophyton rubrum(T. rubrum)感染による爪白癬と診断した.

・テルビナフィンの内服療法のみで爪甲色素線条は消失した.

・爪白癬による爪甲色素線条の診断においてもダーモスコピー所見は有力な検査法と考えられる.

(「症例のポイント」より)

 

A case of melanonychia caused by Trichophyton rubrum in which dermoscopy was useful for diagnosis

 

Kurihara, Mana1)Kimura, Utako1)Tanaka, Masaru3)Hiruma, Masataro4)Takamori, Kenji2)Suga, Yasushi1)

1)Department of Dermatology, Juntendo University Urayasu Hospital

2)Juntendo University

3)Department of Dermatology, Tokyo Women’s Medeical Univercity Medical center East

4)Ochanomizu Institute for Medical Mycology and Allergology

 

A woman in her 60s visited our hospital with the chief complaint of pigmented lines on the nail of the right big toe. Malignant melanoma and pigmented nevus were excluded by dermoscopy. A KOH test was positive for fungal elements, and the causative agent was morphologically and molecular biologically identified as Trichophyton rubrum. We diagnosed the patient as having tinea unguium and melanonychia caused by T. rubrum, and the lesion was considered to be caused by the chromogenic fungus of T. rubrum. The patient was cured with oral terbinafine. A KOH test and fungal culture test are important for diagnosis. In addition, we believe that dermoscopy could be a promising test method.

  • 文献概要を表示

・上口唇白唇部に生じたカンジダ性毛瘡を経験した.

・糖尿病の悪化,軟膏を過剰に塗布したことが発症の誘因と考えた.

・外用の中止とテルビナフィン内服で治癒した.

(「症例のポイント」より)

 

A case of sycosis candidiasis developed in diabetic patient

 

Ota, Michi1)Kitami, Yuki1)Sueki, Hirohiko1)

1)Department of Dermatology, Showa University School of Medicine

 

A 73-year-old male presented with sycosis candidiasis on his upper lip, characterized by erythema, painful pustules, and hair fall. Pseudohyphae and blastospores were detected via direct microscopy of the mustache and crust, and Candida albicans and Candida parapsilosis were identified via culture. We believe this resulted from a complication of uncontrolled diabetes and an overdose of ointment. The patient recovered after oral administration of terbinafine hydrochloride

  • 文献概要を表示

・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.

  • 文献概要を表示

・先天性皮膚カンジダ症を経験した.

・呼吸不全があり,カンジダ肺炎を考慮しリポソームアムホテリシンB投与を行った.

・生後5週から両手にカンジダ性の爪症状が現れた.

・爪症状に対してイトラコナゾール内服を行い8週間後には軽快した.

(「症例のポイント」より)

 

A case of congenital cutaneous candidiasis involved nail changes

 

Ishibe, Junichi1)Ohba, Misao1)Shirahama, Shigeho1)Kibe, Tetsuya2)

1)Department of Dermatology, Seirei-Mikatahara General Hospital

2)Department of Pediatrics, Seirei-Mikatahara General Hospital

 

The patient was a male newborn infant. Generalized erythema, vesicles, and pustules had been observed since birth. Skin cultures yielded Candida albicans, and we made a diagnosis of congenital cutaneous candidiasis. Because the patient’s respiratory status deteriorated, we administered artificial respiratory management until postnatal day 2. Treatment consisted of systemic administration of an antibacterial agents and liposomal amphotericin B. On postnatal day 7 the rash had largely resolved. The patient’s fingernails became opaque during postnatal week 5. We treated the patient with oral itraconazole, and 8 weeks after the start of treatment, his fingernails have been replaced with normal nails.

  • 文献概要を表示

・ほぼ全身にびまん性に紅色丘疹と小膿疱が多発し,膿疱性乾癬を思わせる皮疹を呈し,一見して白癬とは考えられずに診断に苦慮した.

・生毛部のKOH検査で毛外性小胞子菌性寄生を認め,真菌培養にてMicrosporum canis(M. canis)が分離され,飼いネコからも同様の菌が得られたことから飼いネコから感染したM. canis感染症と診断した.

・合併症のない患者にステロイドが誤用されたために誘発された,急性汎発性浅在性白癬の1例を経験し,繰り返しKOH検査を行うことの重要性を改めて痛感した.

(「症例のポイント」より)

 

Acute generalized superficial trichophytosis caused by Microsporum canis, mimicking generalized pustular psoriasis

 

Yokoyama, Kae1)Kimura, Utako1)Kurihara, Mana1)Hiruma, Masataro3)Takamori, Kenji2)Suga, Yasushi1)

1)Department of Dermatology, Juntendo University Urayasu Hospital

2)Juntendo University

3)Ochanomizu Institute for Medical Mycology and Allergology

 

A 30-year-old man presented with generalized pustular psoriasis-like eruptions, comprising red papules and small pustules. Initial KOH examination yielded negative results;however, his symptoms worsened, and he developed fever after using topical steroids. Microscopic examination of the hair revealed hyphae and spores on the exterior surface of the hair shaft. Microsporum canis was isolated by mycological culture. We report a case of acute generalized superficial trichophytosis induced by misdiagnosis and incorrect treatment. When unusual and treatment-resistant rash is observed, repeating KOH examination is important

  • 文献概要を表示

・9歳女児のMicrosporum canis(M. canis)によるケルスス禿瘡を経験した.

・インドネシアに在住しており,ネコとの接触歴があった.

・KOH直接鏡検は陰性であったが,真菌培養や真菌遺伝子解析結果からM. canisを同定した.

・3カ月間のイトラコナゾール(ITCZ)内服にて治癒し,再発は認めていない.

(「症例のポイント」より)

 

A child case of Kerion Celsi Due to Microsporum canis probably infected in Indonesia

 

Mori, Hitomi1)Gommori, Takashi1)Hayashi, Shujiro1)Hamasaki, Youichiro 1)Igawa, Ken1)

1)Department of Dermatology, Dokkyo Medical University, School of Medicine

 

A nine-year-old girl, lived in Indonesia, was introduced to our out patient clinic for her alopecia resistant to topical steroid. Physical examination suggested her alopesia as the result of micro organisms infection and, finally, we diagnosed the lesion as Kerion Celsi by Microsporum canis by the findings of fungal culture and gene analysis. Three-month oral Itraconazole was effective, without any side effect and any recurrences.

  • 文献概要を表示

・爪甲下に膿瘍を形成したAspergillus niger(A. niger)による原発性膿皮症様アスペルギルス症の1例を経験した.

・爪甲内には直接鏡検および病理組織学的に菌要素を認めなかった.

・爪甲下に激しい疼痛を認めたが,指尖部や後爪郭部の炎症所見は認めなかった.

・爪甲の部分的除去による排膿,局所洗浄と抗真菌剤外用のみで治癒した.

(「症例のポイント」より)

 

A case of subungual abscess caused by Aspergillus niger

 

Miyamori, Mutsuki1)Futatsuya, Taketoshi1)Hatta, Junko1)Ushigami, Tsuyoshi1)Anzawa, Kazushi1)Mochizuki, Takashi1)

1)Department of Dermatology, Kanazawa Medical University

 

A 70-year-old Japanese healthy woman with severe pain of the right thumb for 9 days visited our clinic. The nail plate was discolored purplish yellow. Partial removal of the plate revealed abscess formation with an ulcer reaching the dorsal aspect of the phalanx. Histopathological examination showed septate hyphae with calcium oxalate crystals accompanied by marked inflammatory cells with a granulomatous reaction in the dermis. Fungal elements were not observed in the nail plate. Primary cutaneous aspergillosis with Aspergillus niger was diagnosed and the infection was successfully treated by thorough washing of the nail bed and topical application of luliconazole ointment.

  • 文献概要を表示

・Sporothrix globosa(S. globosa)による播種型スポロトリコーシスを経験した.

・免疫異常や基礎疾患のない患者に生じた播種型スポロトリコーシスの本邦邦文報告例はこれまでになく,まれな症例と思われた.

(「症例のポイント」より)

 

Disseminated cutaneous sporotrichosis in an immunocompetent patient

 

Yamazaki, Yuki1)Ishikawa, Takahiro1)Matsuo, Shinsuke1)Nishizawa, aya1)Kamei, Katsuhiko2)Satoh, Takahiro1)

1)Department of Dermatology, National Defense Medical College Hospital

2)Medical Mycology Research Center, Chiba University

 

A 69-year-old woman presented with a 3-month history of erythematous plaques with crusts on the 2nd left finger and multiple subcutaneous nodules on her left forearm. She noted skin lesions approximately one month after the cut injuries with a knife during treating pork meat. The patient also had subcutaneous nodules on her left thigh. Past histories were unremarkable. Histopathological examination of the subcutaneous nodule showed dense cellular infiltrates comprising neutrophils and histiocytes in the deep dermis and subcutaneous tissues. Fungal cultures of the excised specimens resulted in the detection of Sporothrix globosa. No involvement of internal organs was detected. Skin lesions were successfully treated with oral potassium iodide for three months.

  • 文献概要を表示

・丘疹‒紅皮症(太藤)に対し,プレドニゾロン内服中に,左大腿に3個の皮下結節が出現し,一部が潰瘍化した.

・皮膚生検でGrocott染色,PAS染色で菌要素を認め,クリプトコッカス症が疑われた.

・肺病変を認め,血液検査でクリプトコッカス抗原陽性で,播種性クリプトコッカス症と確定診断した.

・抗真菌薬投与および潰瘍の局所処置で治癒した.

(「症例のポイント」より)

 

Disseminated cryptococcosis diagnosed after skin biopsy in a patient with papuloerythroderma (Ofuji) : a case report

 

Fukumoto, Ayako1)Imamura, Shinya2)Nishiyama, Satoshi2)Nishigori, Chikako2)Kamiryo, Hiroshi3) 1)Division of Dermatology, Nishinomiya Municipal Central Hospital 2)Department of Dermatology, Kobe University School of Medicine 3)Division of Respiratory Medicine, Kobe University School of Medicine

 

A 79-year-old man treated with prednisolone (17.5 mg/day)for papuloerythroderma(Ofuji)presented with one ulcerated and two subcutaneous nodules in his left thigh. Pathological examination revealed multiple circular structures of various sizes and specimens were stained positive with Grocott and periodic acid-Schiff. Additional examination revealed pulmonary lesions and the patient was diagnosed with cryptococcosis. He was treated with antifungal drugs for disseminated cryptococcosis and fully recovered. Diagnosing cutaneous cryptococcosis is challenging as it presents various clinical manifestations;therefore skin biopsies are indispensable for accurate differentiation and diagnosis.

  • 文献概要を表示

・免疫抑制患者に発症した皮膚クリプトコッカス症.

・蜂窩織炎様皮疹に始まり,水疱,血疱,潰瘍,壊死,結節を形成した.

・初期には臨床所見に比べ,血液検査上の炎症所見が軽度であった.

・病理所見では血管の閉塞像があり,壊死性筋膜炎に類似した病態が臨床像の形成に関与したと考えられる.

(「症例のポイント」より)

 

Cutaneous cryptococcosis manifesting cellulitis-like appearance

 

Furukawa, Yuki1)Katagiri, Kazumoto1) 1)Department of Dermatology, Dokkyo Medical University Saitama Medical Center

 

A 80 years-old woman gad a fever of 38℃ during hospitalization for the treatment of edema due to hepatocellular carcinoma. Well defined erythema with vigorous tenderness, swelling and local heat developed on an inner aspect of right thigh in spite of administration of antibiotics. Skin biopsy revealed encapsulated yeasts in the edematous dermis with focal lymphocytic infiltration and in the superficial subcutaneous fat with thrombosed vessels. She was finally diagnosed as having cutaneous cryptococcosis based on the results of skin biopsy, and mycological culture, although she had no focus of cryptococcosis in any organs including lung and brain. Vesicles, bullae, ulcers, and necrosis appeared in the erythema within a following week before diagnosis. Necrosis in the thigh expanded and nodules newly appeared on the buttocks and on the left forearm after systemic administration of fluconazole. New cutaneous lesions did not appear after changing to amphotericin B and flucytosine, whereas she died 25 days after development of erythema on her thigh. Cutaneous cryptococcosis should be considered for atypical cellulitis in the immune compromised patients.

  • 文献概要を表示

・体幹・下肢に小水疱を伴う紫斑を散在性に認め,さまざまな鑑別疾患が考えられた.

・皮疹は,肺病変より血行性に播種したムーコル菌によって生じていた.

・免疫抑制状態の患者では,深在性真菌症による紫斑の可能性も念頭に置く必要がある.

(「症例のポイント」より)

 

A case of secondary disseminated cutaneous mucormycosis presenting as purpura

 

Take, Nobutoshi1)Tsuji, Gaku1)Takahara, Masakazu2)Matsuda, Tetsuo3)Furue, Masutaka1) 1)Department of Dermatology, Kyushu University School of Medicine 2)Takahara Dermatology Clinic 3)Matsuda Dermatology Clinic

 

A 65-year-old woman presented with multiple purpura on both legs. Histological examination of the purpura revealed embolus due to a clot in the dermat capillary. The vessels stained positive for fungal elements with PAS stain. Culture test revealed the isolated strain to be zygomycetes. A chest computed tomography scan demonstrated an infiltrative shadow in the left lung field, and Cunninghamella spp. was detected in expectoration culture. We diagnosed the case as secondary disseminated cutaneous mucormycosis from a pulmonary lesion. The patient was treated with amphotericin B liposome preparation (5 mg/kg/day); however, she died in a few days.

editorial

ときに癒し 斉藤 隆三

  • 文献概要を表示

皮膚糸状菌の同定方法は時代とともに変遷しており,かつては培養,鏡検,生化学反応による形態・生化学的同定が主流であったが,現在は分子生物学的手法が普及している.しかし,検査の時間・経済的な課題があり,塩基配列による種分類の解釈や新たな分類をめぐり,逆に混迷を深めている事実もある1).そこで,客観性,再現性が高く,かつ迅速,安価である新たな同定方法が求められている. 近年,微生物菌種同定の新しい手法として,マトリックス支援レーザー脱離イオン化飛行時間型質量分析法(matrix assisted laser desorption ionization - time of flight mass spectrometry:MALDI-TOF MS)を用いた方法が急速に普及している.当院検査部では 質量分析装置 MALDI Biotyper(ブルカージャパン株式会社:図1)を日常臨床検査に使用することで一般細菌の同定が迅速化し,抗酸菌や酵母様真菌にも応用している2).皮膚糸状菌の菌種同定への応用についても,臨床分離株の同定例や新規のデータベース作成を試みた研究が国内外で報告されている.今回天理よろづ相談所病院皮膚科でも,すでに菌種同定されている株,臨床分離株に対して質量分析装置を用いたので,その測定結果と今後の皮膚糸状菌同定への応用の可能性について,MALDI-TOF MSの概要を含め報告する(注:筆者の要石が2019年3月まで,同皮膚科に在籍). 現状では,本法は他の菌種同定法を補完する位置づけであり,今後は前処理方法の標準化や汎用可能な信頼度の高いデータベースの構築などの課題を検討する必要がある.しかしその経済性,迅速性,簡便性などから,次世代の皮膚糸状菌同定の臨床検査法として応用が期待される.(「はじめに」より)

私の歩んだ道

感動と驚きに導かれて 藤本 亘

皮心伝心

診察室の四季

斉藤 隆三

皮膚科のトリビア

第168回

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目次

編集後記・次号予告

基本情報

pd-41-6_cover.jpg
皮膚病診療
41巻6号 (2019年6月)
電子版ISSN:2434-0340 印刷版ISSN:0387-7531 協和企画

文献閲覧数ランキング(
7月6日~7月12日
)