误诊为头皮脓肿经抗生素及植皮治疗无效的脓癣——附2例报告

目的 报道2例误诊为头皮脓肿经长期抗生素及植皮治疗失败的须癣毛癣菌所致的脓癣病患者，分析脓肿和脓癣的鉴别要点。方法 例1为9岁男童，头皮外伤后脓肿、溃疡28d，经抗生素治疗无效，行植皮术后5d再发生脓肿溃疡。取皮损处断发行10％KOH涂片镜检、培养，发现并分离出致病真菌，沙堡弱琼脂培养基上呈白色粉状菌落，可使含尿素培养基变红，即尿素酶试验阳性，小培养见螺旋菌丝及分隔棒状大分生孢子，鉴定为须癣毛癣菌。例2为8岁女童，头顶脓肿、溃疡24d，抗感染治疗不愈而接受植皮，术后7d再发脓性丘疹。从皮损处标本中发现、分离出致病真菌，经上述方法鉴定为须癣毛癣菌。结果 2例患者结合真菌学检查和临床表现确诊为脓癣，予伊曲康唑100mg／d内服近2个月皮损均痊愈，但供皮区遗留瘢痕和色素改变。结论 真菌病原学检查是避免脓癣误诊的关键，伊曲康唑内服治疗脓癣有效、安全。

Kerion misdiagnosed as abscess and mis-treated by antibiotics and dermatoplasty:two cases report

Objective We reported two cases of kerion induced by Trichophyton mentagrophytes misdiagnosed as abscess, and analyzed the differentiation points between keroin and abscess.Methods Case 1 was a 9-year-old boy, who had a history of scalp trauma followed by abscess and ulcer for 28 days. Systemic antibiotics therapy did not work, then he was administered to a dermatoplasty, but abscess recurred 5 days later. A great deal of fugal spore and hyphae were seen in patient's scraping lesion by a 10% KOH preparation, which was identified as Trichophyton mentagrophytes by clavate-shaped macroconidia and spiral hyphae of slide culture and positive urease test. Case 2 was a 8-year-old girl, who had a history of scalp abscess and ulcer for 24 days. She had a similar with the boy mentioned above in course, treatment failed with antibiotics and accepted dermatoplasty, and eruption relapsed few days after surgery.Trichophyton mentagrophytes was isolated from the scrapings of the girl's eruption.Result According to the fungal identification and clinical manifestations, the two cases were finally diagnosed as keroin. They were cured by oral itraconazole(100mg/d) for about 2 months, but remained scar and pigment change on the provided skin area.Conclusion The key point to avoid misdiagnosing keroin is fungal examinations and oral itraconazole is effective and safe to treat keroin.