外伤后细菌性致死性肉芽肿1例实验室检查及尸检报告

Laboratory and autopsy findings of a patient with fetal bacteria granuloma after trauma

目的:报告1例外伤后细菌性致死性肉芽肿患者的诊疗经过,首次报告本病的尸检情况及颅脑磁共振成像检查结果,探讨其病原及死因。方法:采用透射电镜、厌氧培养等方法查找并确定致病菌,进行组织病理学和实验室检查及死后尸体解剖。结果:先后3次从病变组织中分离出一种厌氧的革兰阳性多形性杆菌,其形态、生化特征类似痤疮丙酸杆菌及放线菌,分离出的病原体对大多数抗生素敏感。组织病理学检查提示皮肤损害为肉芽肿改变,尸检明确颅内为肉芽肿性炎症,且颅内病变系致死的原因。结论:本病的病原体是一种革兰阳性多形性杆菌,死因可能为颅内的继发性感染。

Objective: To report a case of fetal bacteria granuloma after trauma and analyze its pathogen and the causes of death. Methods: The anaerobic culture was performed for the tissue and the isolated bacteria were identified by electronic microscopy. Results: The polymorphic anaerobic G+ bacillus was isolated from the skin lesion for three times. Its morphological and biochemical characters were similar to Propionibacterium acnes (P.acnes) and Actinomycetes israelii (A.israelii), which was sensitive to most of the antibiotics. Histopathological examination showed that the lesions on the skin and in the intracalvarium were consisted of granuloma or encephalic granulomous inflammation. Autopsy confirmed that the encephalic granulomous inflammation was the cause of the patient's death. Conclusions: The results of clinic and autopsy suggest that polymorphic anaerobic G+ bacillus is the pathogen and the secondary encephalic infection is the cause of the patient's death.