의인성 쿠싱 증후군 환자에서 발생한 일차성 피부 크립토콕쿠스증: 증례보고 및 문헌 고찰
Primary Cutaneous Cryptococcosis in a Patient with Iatrogenic Cushing’s Syndrome: A Case Report and Review of the Literature
1
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
C. neoformans는 환경에 널리 존재하는 효모균으로 주로 면역억제 환자에서 기회감염을 일으킨다. 피부 침범은 전신성 크립토콕쿠스증 환자의 약 10-15%에서 볼 수 있으며, 전신적 질환 없이 피부 병변만 나타나는 일차성 피부 크립토콕쿠스증은 드물고, 최근에는 별도의 질환군으로 생각되고 있다. 저자들은 의인성 쿠싱 증후군 환자에서 C. neoformans에 의한 일차성 피부 크립토콕쿠스증을 경험하여 보고하는 바이다. 73세 여자 환자가 좌측 팔의 삼출성 궤양과 동통을 주소로 내원하였다. 환자는 20년 동안 경구 스테로이드를 복용하였고 그 결과, 의인성 쿠싱 증후군이 발생하였다. 궤양 변연부의 조직에서 얻은 검체를 배양한 결과 효모균 집락을 관찰할 수 있었다. 효모균은 urease를 생성하였으며, Vitek2 system (Vitek2 ID-YST, bioMérieux, Marcy l’Etoile, France) 및 API 20C (bioMérieux)에서 C. neoformans로 동정되었다. 함께 시행한 혈액 배양 및 뇨 배양에서는 균이 검출되지 않았다. 세균성 봉와직염으로 판단해 항균제 치료를 하였으나 배양 결과가 보고된 후 원발성 피부 크립토콕쿠스증으로 진단하고, 치료로 외과적 변연 절제술과 fluconazole 정주요법 및 경구 투약 요법을 지속하여 병변은 반흔을 남기고 치유되었다. 결론적으로 항균제에 잘 치유되지 않는 피부 병변의 경우 원발성 피부 크립토콕쿠스증의 가능성도 고려해야 하며, 정확히 동정하여 적절한 치료를 하는 것이 중요하다.
Abstract
Cryptococcus neoformans (C. neoformans) is a ubiquitous yeast-like fungus that has been a common opportunistic human pathogen, especially in immunocompromised patients. Although skin lesions due to C. neoformans are found in 10-15% of patients with systemic cryptococcosis, primary cutaneous cryptococcosis without systemic infection is rare and now considered a distinct clinical entity. We report a case of primary cutaneous cryptococcosis in a patient with iatrogenic Cushing’s syndrome. A 73-year-old woman presented with pain and discharge from lesions on her left forearm. The patient had been treated with oral corticosteroids for 20 years, and as a result had developed iatrogenic Cushing’s syndrome. A skin fragment of the ulcer was cultured, and the encapsulated fungus were isolated and identified as C. neoformans using a Vitek2 system (Vitek2 ID-YST, bioMérieux, France) and API 20C (bioMérieux). Concurrent blood and urine cultures were negative for growth. At first, she was treated with antibiotics due to suspicion of cellulitis. After surgical resection and treatment with systemic and oral fluconazole, her wound was improved with scar. Primary cutaneous cryptococcosis should be considered when skin lesions are not responsive to antibiotics and accurate identification is important for proper treatment.
참고문헌 (19)
- Ellis DH, "Ecology, life cycle, and infectious propagule of Cryptococcus neoformans", Lancet, 336, pp.923~925 (1990)
- Levitz SM, "The ecology of Cryptococcus neoformans and the epidemiology of cryptococcosis", Rev Infect Dis, 13, pp.1163~1169 (1991)
- Ruiz A, "Distribution of Cryptococcus neoformans in a natural site", Infect Immun, 31, pp.560~563 (1981)
- Kumlin U, "Cryptococcosis and starling nests", Lancet, 351, pp.1181~ (1998)
- Fitzpatrick TB, "Dermatology in general medicine. 4th ed" (1993), McGraw-Hill, Health Professions Division
- Anderson DJ, "Cryptococcal disease presenting as cellulitis", Clin Infect Dis, 14, pp.666~672 (1992)
- Neuville S, "French Cryptococcosis Study Group. Primary cutaneous cryptococcosis: a distinct clinical entity", Clin Infect Dis, 36, pp.337~347 (2003)
- Probst C, "Cryptococcosis mimicking cutaneous cellulitis in a patient suffering from rheumatoid arthritis: a case report", BMC Infect Dis, 10, pp.239~ (2010)
- Hernandez AD, "Cutaneous cryptococcosis", Dermatol Clin, 7, pp.269~274 (1989)
- Powderly WG, "Cryptococcal meningitis and AIDS", Clin Infect Dis, 17, pp.837~842 (1993)
- Gatti M, "Primary unusual cutaneous cryptococcosis in an HIV former drug-abuser patient", Mycoses, 40, pp.101~102 (1997)
- Romano C, "Primary cutaneous cryptococcosis due to Cryptococcus neoformans in a woman with non-Hodgkin's lymphoma", Acta Derm Venereol, 81, pp.220~221 (2001)
- Zorman JV, "Primary cutaneous cryptococcosis in a renal transplant recipient: case report", Mycoses, 53, pp.535~537 (2010)
- Kim YJ, "A case of primary cutaneous cryptococcosis misdiagnosel as skin tuberculosis", Korean J Med Mycol, 8, pp.16~20 (2003)
- Shin DH, "Primary cutaneous cryptococosis", Ann Dermatol, 11, pp.27~29 (1999)
- Kim HJ, "Two cases of cutaneous cryptoccosis mimicking cellulitis", Korean J Med Mycol, 3, pp.190~194 (1998)
- Kang HY, "Primary cutaneous cryptococcosis treated with fluconazole", Korean J Dermatol, 38, pp.838~840 (2000)
- Park JH, "Primary cutaneous cryptococcosis successfully treated with fluconazole", Ann Dermatol, 12, pp.148~151 (2000)
- Pau M, "Primary cutaneous cryptococcosis in an immunocompetent host", Mycoses, 53, pp.256~258 (2010)