薬剤関連の爪水虫症．症例報告

Drug-related talaromycosis: A case report.

• Yongsheng Lu
• Quan Shi
• Jing Yu

抄録

タラロ真菌症は、.NETの薬物による稀な深在性真菌感染症である。現在、覚せい剤は大麻に次いで世界第2位の薬物乱用カテゴリーとなり、深刻な公衆衛生上の問題となっています。覚せい剤はヒトの免疫系を阻害し、病原性微生物の感染確率を高める可能性があります。2016年10月8日、2ヶ月間の発熱歴を持つ20歳の男性が当院に入院しました。入院中に血便と腹痛を認めた。身体所見では目立った異常は認められなかった。誤診のため不適切な治療を受けた．周期性酸シッフ染色（PAS）により，回腸遠位粘膜，上行結腸，横行結腸，シグモイド結腸の粘膜に多数の組織細胞が浸潤しており，青紫色の粒子を多数含んでいた．また、回腸粘膜前膜には多数の組織球や多核巨細胞が認められ、組織球には真菌胞が認められた。最終的にはタラロ真菌症と診断され、イトラコナゾール0.2gを1日2回内服した。5日後には体温も平熱に下がり炎症も消失し、6ヶ月間イトラコナゾールを服用し続けた。薬物乱用の既往歴の軽視と隠蔽により、薬物関連タラロ真菌症は誤診されることが多い。爪水虫症の診断には病理学的検査が必要である。長期の抗真菌治療が必要です。

Talaromycosis is a rare deep fungal infection caused by . Currently, methamphetamine has become the second-largest drug abuse category in the world after cannabis and has become a serious public health problem. Methamphetamine can inhibit human immune system and increase the probability of pathogenic microorganism infection. On 8 October 2016, a 20-year-old man with a fever history of 2 months was admitted to our hospital. He had bloody stools and abdominal pain during hospitalization. There was no significant abnormality in physical examination. Because of the misdiagnosis, he underwent improper treatment. Periodic acid-Schiff stain (PAS) staining showed that the mucosa of distal ileum, ascending colon, transverse colon, and sigmoid colon were infiltrated by a large number of tissue cells, which contained a large number of blue purple particles. In addition, a large number of histiocytes and multinucleated giant cells can be seen in the lamina propria of ileum mucosa, and fungal spores can be seen in histiocytes. Finally, he was diagnosed as talaromycosis and took itraconazole 0.2 g twice a day. After 5 days, the temperature dropped to normal and the inflammation disappeared, and he continued to take itraconazole for 6 months. Due to the neglect of the history of drug abuse and the concealment, drug-related talaromycosis is often misdiagnosed. Pathological examination is warranted for diagnosis talaromycosis. This condition requires a long-term anti-fungal therapy.