猫抓病2例临床病理分析

Clinical pathologic analysis of the cat-scratch diseases

目的探讨猫抓病的临床病理学特征、诊断及鉴别诊断。方法对2例猫抓病进行临床病理分析，应用Warthin—Starry嗜银纤维染色进行诊断和鉴别诊断。结果2例猫抓病患者，1例有明确的被猫咬伤手指史，1例可疑被猫抓咬病史。镜下见大量淋巴结构破坏，多发性、大小不一的圆形结节性肉芽肿性病变。结节中央为含嗜中性粒细胞的中心性坏死，其间见少量类上皮细胞、多核巨细胞等。肉芽肿性结节为非干酪样坏死性。Warthin—Starry嗜银纤维染色发现结节内有大量阳性杆菌。结论猫抓病常见的病原体为巴尔通氏体，其淋巴结肉芽肿的病理组织学变化酷似性病性淋巴肉芽肿、非干酪性结核等。可根据临床病史、特殊皮肤试验、病理组织学改变及嗜银纤维染色来加以诊断和鉴别诊断。

Objiective To explore clinical pathologic characteristics, diagnosis and differential diagnosis of the cat-scratch diseases. Methods 2 patients with cat-scratch diseases were analyzed by histological observation and Warthin-Starry argentaffine fibers stain. Results One patient had a clearly medical history bitten finger by a roam about cat. Histologically, the nodular was composed of epithelioid cells, multinuclear giant cells with a central necrotic. Conclusions The common etiology of the cat-scratch disease were Bartonella hensellae. These lesions greagly re- semble those of lymphogranuloma venereum and non-caseous tuberculosis. The diagnosis and differential diagnosis was based on the history, a specific cutaneous test and Warthin-Starry argentaffine fibers stain.