弥漫性结缔组织病伴皮肤软组织结核六例临床分析并文献复习

Analysis of 6 cutaneous and soft tissue tuberculosis cases in patients with diffuse connective tissue disease and literature review

目的分析弥漫性结缔组织病（DCTD）伴皮肤软组织结核（CSTB）的临床特点。方法对我院2003年7月至2008年10月收治的6例DCTD伴CSTB感染患者进行回顾性分析并复习相关文献。结果6例患者在应用糖皮质激素和免疫抑制剂12～19个月内患CSTB。CSTB的发生部位分别为大腿、臀部、小腿、前臂、颈部和上臂。其中4例形成窦道同时合并普通细菌感染。从CSTB发病到确诊的时间为1～11个月。经抗结核治疗6个月后，1例痊愈，3例好转，2例未愈。结论CSTB感染是DCTD伴结核感染的少见类型，容易误诊和延迟诊断，当DCTD在治疗过程中出现皮肤软组织的炎症表现时，应警惕结核感染，尽早完善结核的相关检查，必要时可试行诊断性抗结核治疗。

Objective To analyze the clinical features of cutaneous and soft tissue tuberculosis （CSTB） infection in patients with diffuse connective tissue disease （DCTD）. Methods Six cases of diffuse connective tissue disease with CSTB in our hospital from 2003 to 2008 were studied retrospectively and literatures were reviewed. Results Six cases were diagnosed CSTB infection after taking immunosuppressive agents for 12-19 months. The locations of CSTB were in the thigh , hip, leg, antebraehium,,cervical area and upper arm. Sinus tracts were formed in four of six complicated by common bacterial infection. It was 1-11 months interval between the onset of the symptoms and the diagnosis of CSTB. One case was cured, three were improved and another two cases were not improved after 6 months anti-TB therapy. Conclusion CSTB is the rare subtype of TB infection, especially in DCTD patients, thus it is often misdiagnosed or the diagnosis is delayed. If the cutaneous and soft tissue inflammation occurs during the therapy of DCTD, the examinations for TB should be done. If necessary, diagnostic therapy of CSTB should be carried out.