反射式共聚焦显微镜联合皮肤镜辅助诊断马尔尼菲篮状菌病1例OA

We report a case of talaromycosis diagnosed with the assistance of reflectance confo-cal microscopy(RCM)and dermoscopy.A 38-year-old man presented with a one-week history of asymptomatic papules and nodules on the face.Dermatological examination revealed scattered or clustered skin-colored to erythematous papules and nodules ranging from rice grain to soybean size.The surface was smooth or umbilicated,with some lesions showing focal erosion covered by purplish-red hemorrhagic crusts.RCM examination showed that the spinous layer appeared thinned with widened dermal papillae.The superficial dermis contained highly refractive fine granular ma-terial that aggregated into globular structures resembling"grapes or mulberries".Dermoscopy re-vealed a light red or skin-colored background with focal distribution of dotted and thin linear ves-sels,along with adherent yellowish-brown scales.Some lesions showed patchy purplish-red spots.Based on these RCM and dermoscopic findings,an initial suspicion of Talaromyces marneffei infec-tion was raised.The patient was treated with oral itraconazole tablets,resulting in gradual regres-sion of the lesions.At follow-up,a skin biopsy was performed.Histopathology showed mild hyper-keratosis and epidermal attenuation with numerous blue-gray spores in the superficial dermis,some forming clusters.Periodic acid-Schiff(PAS)staining highlighted red-stained spores,some displa-ying a central transverse septum.Fungal culture confirmed the diagnosis of Talaromyces marneffei(formerly Penicillium marneffei).The patient showed excellent clinical response to itraconazole.After two months of follow-up,the skin lesions had almost completely resolved.The patient was subsequently lost to follow-up.