顔面に生じた Paecilomyces lilacinus 感染症の 1

1 Jpn. J. Med. Mycol. Vol. 46, 267 272, 2005. ISSN 0916 4804.. Paecilomyces lilacinus 1 .. 3 15 , 2005 , 6 27 , 2005 .. 74 Paecilomyces lilacinus 1 . 1 8 . , , . 1 , , . 3 , . , . , . , , .. , . P. lilacinus .. 500 mg/ 3 . 200 mg/ 300 mg/ . 400 mg/ 1 , 3 3 . Key words: Paecilomyces lilacinus Paecilomyces lilacinus infection , itraconazole , . pulse therapy .. Fig. 1 . Paecilomyces , WBC 4400/ l, RBC 336 104/ l, Hb . P. lilacinus , P. variotii, P. g/dl, Ht , PLT 104/ l.. fumosoroseus, P. viridis 4 , CRP . 1 , , .. 74 P. lilacinus , , . 1 .. HE . , .. solar elastosis , . 74 , .. 2003 4 28 , , , , .. PAS , Fig. 2.

2 2001 8 . mg/ , 2 / KOH . Fig. 3 .. 1 , Sabouraud Czapeck-Dox .. , . , 2003 1 28 Fig. 4 , 40 C .. , .. 125 mg/ , . 2 Fig. 5-a . , .. Fig. 5-b . , m, 5 m, . 1 m, . 142-8666 1-5-8 m . P. lilacinus . MIC .. 268 46 4 17 . Fig. 1. Dark reddish or brownish plaque, papules, and small cutaneous nodules were observed on the right side of her face. Fig. 2. Fungal hyphae in pus from nodule on right cheek Parker Fig. 3. Fungal hyphae in the middle layer of the dermis Grocott KOH stain 400 stain 400 . , . 2 , . MIC . Table 1 .. , 10 1. 10 mg, 1 1 .. 2 , . , 1 500 mg .. 3 . , . , . MIC . 1 200 mg . 4 . , 1. Fig. 4. On Czapek-Dox agar at 25.

3 C, the colony was a lilac shade. 300 mg .. Jpn. J. Med. Mycol. Vol. 46 No. 4 , 2005 269. 1 mg , . 2 .. 7 , , 9 9 . , 1 400 mg 1 .. 9 , . 9 30 . , .. , . , 1 . 100 mg 1 .. , 10 24 , . Paecilomyces . , 3 1 5 mg , 1 150 mg 2 . 2 . , , .. 2004 5 .. , . P. lilacinus . 1 . 400 mg 1 , 3 . Table 1. Antifungal susceptibility of P. lilacinus isolate MIC g/ml . Drug before ITCZ pulse therapy . ITCZ FLCZ MCZ 5-FC 64. Fig. 5. Slide culture shows hyphae and long tapering flask-shaped AMPH 16 16. phialides with extended chains of oval conidia lactophenol MCFG cotton blue stain a- 200, b- 1000 . Fig. 6. After three cycles of itraconazole pulse therapy, papules and nodules were cleared.

4 270 46 4 17 .. 3 , 22, 27, 28 . Fig. 6 . , , .. , .. 8 24 26, 29 32 , 5 26, 29 32 . P. lilacinus , . 1 200 400 mg . 1974 Samson , 4 7 . Penicillium Paecilomyces 2 .. Paecilomyces , , , . 1 200 mg . , P. lilacinus . , 1 300 mg . , . , .. , . Penicillium .. 1 . 1 . Paecilomyces 400 mg 1 , 3 . , , .. 1976 Takayasu 3 20 1 . 18 .. 10 3 11 , 7 12 17 , . 1 18 Table 2 . , . 3 9, 10 1 . 10 .. MEDLINE , P. lilacinus , . 1984 Cho 19 37 , , .. , 47 , . , . , . , . , . 20 24 .. 21, 22, 25 , 26 , . Table 2. Reported cases of Paecilomyces sp. infection in Japan Year Authors Age/sex Site of infection Spiecies Predisposing factors Treatment 1 1976 Takayasu et 20 F Left cheek, chin P.

5 lilacinus None Griseofulvin Disinfection with iodine, 2 1976 Arai and Endo4 28 F Right hand, forearm P . lilacinus Renal transplant Amphotericin B. 3 1979 Okabe et 50 M Right thumb P. lilacinus None Griseofulvin Thimerosal, Pimaricin 4 1979 Ando et 45 F Oculomycosis P. lilacinus Injury 5FC, Griseofulvin SLE. 5 1981 Kawaguchi et 27 F Right cheek P. lilacinus Diabetes mellitus Griseofulvin 6 1983 Seki et 29 M Mycotic pyothorax P. lilacinus None Operation 7 1984 Takatsuki et 70 M Oculomycosis P. lilacinus Diabetes mellitus Thimerosal Corneoscleral trephining 8 1985 Watanabe et 52 M Endophthalmitis P. lilacinus Amphotericin B.

6 Surgery 9 1986 Nakama et 53 M Left sole P. variotii None NR. IgA nephropathy 10 1986 Odashima et 46 M Left forearm P. lilacinus Thermotherapy Predonine therapy 11 1990 Yokoyama et 90. F Keratomycosis P. lilacinus Diabetes mellitus Anti-fungal drugs were not effective 12 1994 Ohkubo et 84 F Endophthalmitis P. lilacinus Diabetes mellitus Econazole, Thimerosal, Miconazole Amphotericin B, Itraconazole, 13 1996 Tanaka et 40 F Leg Paecilomyces sp. Evans syndrome Surgical excision 14 1998 Hosoe et 64 M Right forearm P. lilacinus Diabetes mellitus Griseofulvin 15 1999 Shirai et NR Left leg P. lilacinus MDS Polymyxin B.

7 16 2003 Suzuki et 81 M Keratomycosis Paecilomyces sp. Injury NR. 17 2003 Suzuki et 83 M Keratomycosis Paecilomyces sp. Surgery NR. Autoimmune hemolytic Itraconazole pulse therapy 18 2004 PR 74 F Right cheek P. lilacinus anemia PR: present report NR: not reported Jpn. J. Med. Mycol. Vol. 46 No. 4 , 2005 271.. MIC 1 . 98: 103 110, 1994.. , 17 , , , , , . , 13 .. 45: 1183 1188, 2003.. 18 , , , , , , , , , , . , , : Paecilomyces lilacinus .. 1 . 2: 276 281, 1983. 19 Cho GY, Choo EH, Choi GJ, Hong NS, Houh W: 48 Facial cutaneous mycosis by Paecilomyces lilacinus . Korean J Dermatol 22: 89 93, 1984.. 20 Castro LGM, Salebian A, Sotto MN: Hyalohyphomycosis by Paecilomyces lilacinus in a renal transplant patient and a review of human Paecilomyces species infections.

8 1 , , : . J Med Vet Mycol 28: 15 26, 1990. , , , 299, 21 Heinz T, Perfect J, Schell W, Ritter E, Ruff G, , , 1987. Serafin D: Soft-tissue fungal infections: surgical 2 Samson RA: Paecilomyces and some allied hyphomycetes. management of 12 immunocompromised patients. Studies in mycology. , Centraalbureau Plast Reconstr Surg 97: 1391 1399, 1996. voor Schimmelcultures, Baarn, The Netherlands, 1974. 22 Liu K, Howell DN, Perfect JR, Schell WA: Morphologic 3 Takayasu S, Akagi M, Shimizu Y: Cutaneous mycosis criteria for the preliminary identification of Fusarium, caused by Paecilomyces lilacinus . Arch Dermatol 113: Paecilomyces , and Acremonium species by histopathology.

9 1687 1690, 1977. Am J Clin Pathol 109: 45 54, 1998. 4 , 23 Blackwell V, Ahmed K, O'Docherty C, Hay RJ: Fonsecaea pedrosoi Paecilomyces lilacinus 1 . Cutaneous hyalohyphomycosis caused by Paecilomyces 31: 481 487, 1977. lilacinus in a renal transplant patient. Br J Dermatol 5 , , Paecilomyces 143: 873 875, 2000. 1 . 20: 60, 1979. 24 Hilmarsdottir I, Thorsteinsson SB, Asmundsson P, 6 , , , , Bodvarsson M, Arnadottir M: Cutaneous infection SLE Paecilomyces lilacinus caused by Paecilomyces lilacinus in a renal transplant 1 . 22: 50, 1981. patient: treatment with voriconazole. Scand J Infect 7 , , , , Dis 32: 331 332, 2000.

10 27: 51, 1986. 25 Clark NM: Paecilomyces lilacinus infection in a heart 8 , , , Paecilo- transplant recipient and successful treatment with myces lilacinus 1 . terbinafine. Clin Infect Dis 28: 1169 1170, 1999. 27: 30, 1986. 26 Hecker MS, Weinberg JM, Bagheri B, Tangoren IA, 9 , , , , Rudikoff D, Bottne E, Bilodeau-McCarthy E, Rudolph , , Cryptococcus RI, Phelps RG: Cutaneous Paecilomyces lilacinus infection: , Paecilomyces Evans report of two novel cases. J Am Acad Dermatol 37: . 50 7, 1996. 270 271, 1997. 10 , , Paecilomyces 27 Jade KB, Lyons MF, Gnann JW: Paecilomyces lilacinus . 108: 588, 1998. cellulitis in an immunocompromised patient.