심재성 피부 진균증의 임상 및 조직병리학적 특성 = Clinical and Histopathological Characteristics of Deep Cutaneous Fungal Infections

다국어 초록 (Multilingual Abstract)

Background: Deep cutaneous fungal infections (DCFIs) involve fungal invasion of the dermis or subcutis and exhibit diverse clinical manifestations that often mimic other dermatologic conditions. Although histopathology and fungal culture are essential diagnostic tools, discordance between these modalities frequently limits the diagnostic accuracy.
Objective: To evaluate the clinical features, histopathologic characteristics, causative organisms, and diagnostic concordance of DCFIs and to compare outcomes according to host immune status.
Methods: A retrospective review of all DCFI cases diagnosed at Chungnam University Hospital between 2001 and 2020 was conducted. Demographic and clinical information, including lesion morphology and immune status, was obtained from medical records. Skin biopsy findings and tissue fungal cultures were reviewed to assess diagnostic yield, and clinical characteristics and outcomes were compared according to immune status.
Results: A total of 19 patients were diagnosed with DCFI, and 14 (73.7%) were immunocompromised. Of these, 12 patients (63.2%) had primary infections, and seven (36.8%) had systemic infections. Plaques were the most common clinical presentation (57.9%), and granulomatous inflammation (68.4%) was the most frequent histopathologic finding. Fungal elements were identified on H&E staining in 94.7% of cases and with special stains in 93.8%, whereas tissue culture was positive in only 53.3%. Immunocompromised patients showed higher rates of dissemination, with a mortality rate of 35.7%, whereas all immunocompetent patients survived.
Conclusion: DCFIs show variable clinical morphology, necessitating early diagnosis. Histopathology demonstrated superior sensitivity of fungal cultures. Host immunosuppression is strongly associated with disease dissemination and poor prognosis, underscoring the need for early recognition and timely antifungal treatment.