目的分析真菌感染致坏疽性臁疮的临床特点、病理特点、病原菌种类、诊断及治疗方法。方法报告1例尖孢镰刀菌感染致坏疽性臁疮,并对1977-2015年真菌感染致坏疽性臁疮文献进行复习。结果患者男,17岁。右小腿胫前皮损3个月。取痂下坏死组织直接镜检见大量菌丝,真菌培养(SDA)见白色棉絮状菌落生长。扫描电镜观察见镰刀形大分生孢子。提取菌株DNA,对ITS,TEF-1α,BT2基因片段进行PCR扩增、测序、比对,鉴定为尖孢镰刀菌。予口服伊曲康唑治疗2周后,皮损稍好转,后失访。25例已报道病例中,男13例,女12例;年龄12d~69岁,中位年龄15岁。最常见基础疾病是血液系统恶性肿瘤(17例,占68.00%),包括急性白血病14例、淋巴瘤2例、多发性骨髓瘤1例。皮损部位:四肢或臀部23例(92.00%),躯干10例(40.00%),头面部4例(16.00%)。致病菌:镰刀菌7例(28.00%),毛霉目真菌7例(28.00%),念珠菌6例(24.00%),黑曲霉、双间柱顶孢、金龟子绿僵菌、弯孢菌和明脐霉各1例,分别占4.00%。21例(84.00%)予系统性抗真菌治疗,9例(36.00%)予外科治疗,包括外科清创术(4例)和手术切除局部皮损(5例)。15例(60.00%)治愈,1例(4.00%)好转,1例(4.00%)失访,8例(32.00%)死于本病,均为播散性感染。结论真菌感染致坏疽性臁疮主要发生于免疫受损患者,以白血病患者最多见,皮损好发于四肢或臀部,毛霉目真菌、镰刀菌和念珠菌是其最常见致病菌。播散性感染病死率高,及早诊断并合理治疗是治疗成功的关键。 Objective To analyze the clinical features, pathological features, pathogenic bacteria, diagnosis and treatment of gangrenous scabies caused by fungal infection. Methods A report of 1 case of gangrenous spongiform encephalopathy caused by Fusarium oxysporum infection was reviewed, and the literature on gangrenous scabies caused by fungal infection from 1977 to 2015 was reviewed. Results Male patient, 17 years old. Right lower leg anterior tibial lesions 3 months. Take a large number of mycelium direct microscopic examination of necrotic tissue under the scab, fungus culture (SDA) see white cotton floc growth. Scanning electron microscopy observed sickle conidia. The strain DNA was extracted and the ITS, TEF-1α and BT2 gene fragments were amplified by PCR, sequenced and compared to identify Fusarium oxysporum. After oral administration of itraconazole for 2 weeks, the skin lesions slightly improved, lost after the visit. Among the 25 reported cases, 13 were males and 12 were females; their ages ranged from 12 days to 69 years with a median age of 15 years. The most common underlying diseases were hematological malignancies (17 cases, 68.00%), including 14 cases of acute leukemia, 2 cases of lymphoma and 1 case of multiple myeloma. Skin lesions: 23 cases (92.00%) of limbs or buttocks, 10 cases of trunk (40.00%), head and face in 4 cases (16.00%). Pathogenic bacteria: Fusarium in 7 cases (28.00%), Mucorales in 7 cases (28.00%), Candida 6 (24.00%), Aspergillus niger, Acremonium, Metarhizium anisopliae, And 1, each of which accounted for 4.00%. Twenty-one patients (84.00%) were treated with systemic antifungal therapy and 9 patients (36.00%) were treated surgically, including surgical debridement (4 cases) and surgical excision of the local lesion (5 cases). 15 cases (60.00%) were cured, 1 case (4.00%) was improved, 1 case (4.00%) was lost and 8 cases (32.00%) died of this disease, all of which were disseminated infections. Conclusions Fungus-causing gangrenous scabies mainly occurs in immunocompromised patients, most of them are leukemia patients. Skin lesions occur in the extremities or buttocks. Mucorales, Fusarium and Candida are the most common pathogenic bacteria. Disseminated infection high mortality, early diagnosis and reasonable treatment is the key to the success of treatment.