抄録
The patient was a 33-year-old man. He had had tinea capitis and tinea glabrosa from his childhood. In addition, finger tip-to hen egg-sized masses developed on the occipital and nuchal regions. On incision they discharged abundant pus, and fistulas, difficult to heal, were left. Fistulas were also developed spontaneously. With years, many subcutaneous abscesses and fistulas appeared one after another on the back; neck and chest. Some lesions showed fluctuation on palpation. Pustules, ulcers and scars were seen between the above lesions. The covering of the pustules was thin and could be broken easily. The fistulas were 0.5 to 1.0 cm deep and some extended burrow-ing horizontally by 3-4 cm. Ulcers were shallow and not beyond coin size. Their floor was uneven. A thumb tip sized hemispherical tumor was present on the fore-chest and a similar tumor of hen egg size was seen on the side of the chest. They fluctuated on plapation and were covered with normal skin. Puncture of the tumors re-vealed much purulent material, which showed the lesions to be deep-seated abscesses. They were not tender on pressure. Spontaneous pain was not complained of either. Erythemato-squamous plaques, nail to palm sized, were seen on the trunk and the extremities. Nails of the right thumb and the right IV finger were discolored and deformed. A few lymphnodes were swollen to thumb tip size in the occipital region and axillas. A lymphnode in the left thigh was also swollen to hen-egg size. The above lymphnodes were shown to contain abundant pus on incision.
In the KOH preparations of the scales of plaque-like lesions, the pus and the nail, numerous mycelium threads were detected. Histologic examination revealed numerous mycelia in the dermis, the subcutaneous tissue and the affected lymphnodes on PAS staining. No colony grew on Sabouraud's glucose agar inoculated with pus or specimen from the deeper suppurative lesion. Brain heart infusion glucose blood agar was used successfully to culture colonies of the suspected fungus. The isolated fungus was identified as T. ferrugineum, though T. verrucosum was also considered. The patient had been treated unsuccessfully with antibiotics, antiphthisica, adrenocortical hormones, potassium iodide and griseofulvin. After amphotericin B was administrated by intravenous dripping for 40 days (700 mg in total), the lesions were remarkably improved.
