A 55-year-old male patient presented with plaques on the face for more than 20 years,and no immunodeficiency diseases were diagnosed.Skin examination showed large areas of pink plaques on the nose,bilateral cheeks and upper oral lips with slight desquamation,verrucous hyperplasia on the dorsal area of the nose,and a bean-sized verrucous protuberance on the tip of the nose.Histopathological examination of the skin lesions revealed pseudoepitheliomatous hyperplasia in the epidermis and hyphae-like structures in the stratum corneum.Moreover,there was diffuse infiltration of inflammatory cells in the dermis,which mainly included neutrophils,lymphocytes,histiocytes and multinucleated giant cells.Periodic acid-Schiff (PAS)-positive spore-like structures were observed in the multinucleated giant cells.Culture of the lesional tissues on Sabouraud dextrose agar (SDA) medium showed grey-brown villous colonies.Microculture on the potato dextrose agar (PDA) medium yielded dark septate hyphae and pycnidia filled with a large number of spores.Microsphaeropsis arundinis was identified by fungal molecular biological techniques.The patient was diagnosed with cutaneous phaeohyphomycosis caused by Microsphaeropsis arundinis.The patient was treated with CO2 laser for the removal of verrucous protuberance on the tip of the nose,and oral itraconazole capsules at a dose of 200 mg twice a day.After 3-month treatment,the skin lesions subsided and the drug was withdrew.During 6-month follow-up,no relapse occurred.%患者男,55岁,面部斑块20余年,未发现合并免疫缺陷疾病.皮肤科检查:鼻部、双面颊、口唇上方大片淡红色斑块,少量脱屑,鼻背部疣状增生,鼻尖1个黄豆大小的疣状突起物.皮损组织病理检查:表皮假上皮瘤样增生,角质层中可见菌丝样结构.真皮内弥漫炎症细胞浸润,主要有中性粒细胞、淋巴细胞、组织细胞以及多核巨细胞.在多核巨细胞内见孢子样结构,过碘酸-雪夫染色阳性.皮损组织沙氏葡萄糖琼脂培养基培养出灰褐色绒毛状菌落.玻片小培养(马铃薯葡萄糖琼脂培养基)见内含大量孢子的分生孢子器及分隔分支的暗色菌丝.真菌分子生物学鉴定为Microsphaeropsisarundinis.诊断为Microsphaeropsis arundinis所致皮肤暗色丝孢霉病.治疗:CO2激光去除鼻尖部位疣状突起,口服伊曲康唑胶囊200 mg,每天2次,3个月后皮损消退停药,随访6个月无复发.
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