结核硬脂酸棒状杆菌致肉芽肿性乳腺炎合并下肢结节性红斑一例并文献复习

A case of granulomatous mastitis complicated with erythema nodosum of the lower extremities caused byand literatures review

目的探讨结核硬脂酸棒状杆菌致肉芽肿性乳腺炎合并下肢结节性红斑的诊断及治疗措施。方法分析浙江省人民医院2022年3月28日收治的1例结核硬脂酸棒状杆菌致肉芽肿性乳腺炎合并下肢结节性红斑患者诊疗过程并结合相关文献复习。结果1例30岁的青年女性患者,因左侧乳房肿块伴疼痛半月余至本院就诊,口服头孢呋辛酯抗感染疗效不佳,经组织病理、穿刺液培养及16S rRNA序列分析确诊为结核硬脂酸棒状杆菌致肉芽肿性乳腺炎合并下肢结节性红斑,药敏试验结果提示万古霉素、利奈唑胺敏感,随后予以脓肿切开引流结合药物治疗(利奈唑胺和泼尼松)后,肿块明显缩小且炎症好转,予以出院。结论结核硬脂酸棒状杆菌感染致肉芽肿性乳腺炎合并下肢结节性红斑罕见,易误诊误治,应结合细菌/真菌培养、16S rRNA序列分析以及药敏试验等技术明确病原菌,进行针对性抗感染治疗。

Objective To investigate the diagnosis and treatment of granulomatous mastitis with erythema nodosum in lower limbs caused by Corynebacterium tuberculosis.Methods The diagnosis and treatment process of a patient with granulomatous mastitis caused by Corynebacterium tuberculosis complicated with erythema nodosum in lower limbs admitted to Zhejiang Provincial People’s Hospital on March 28th,2022 was analyzed and related literatures were reviewed.Results This case was a 30-year-old young female patient who was admitted to Zhejiang Provincial People’s Hospital for a half-month period of pain due to the left breast mass.The oral cefuroxime axetil had poor anti-infective treatment effect.The diagnosis was confirmed by histopathology,puncture fluid culture and 16S rRNA sequence analysis as granulomatous mastitis caused by Corynebacterium tuberculosis with erythema nodosum in lower limbs.The results of drug sensitivity test showed that vancomycin and linezolid were sensitive.Subsequently,abscess incision and drainage combined with drug treatment(linezolid and prednisone)were performed,and the mass reduced significantly and the inflammation improved,and the patient was discharged.Conclusions Granulomatous mastitis complicated with erythema nodosum of lower limbs caused by Corynebacterium tuberculosis infection is rare,which is easy to be misdiagnosed and mistreated.Bacterial/fungal culture,16S rRNA sequence analysis and drug sensitivity test should be combined to identify the pathogenic bacteria and carry out targeted anti-infective treatment.