游泳池肉芽肿三例

Three cases of swimming pool granuloma

例1女，40岁，右手及前臂结节斑块2个月，否认外伤史，但从事热带鱼销售。体检示右手手指、腕、肘关节旁暗红色结节斑块，右上肢多发串珠样皮下结节。例2女，48岁，左手及前臂结节斑块2个月。发病前有清洗热带鱼鱼缸及过滤网外伤史。体检示左手、腕、前臂及上臂散在暗紫红色斑块及无痛性皮下结节。例3男，39岁，双手指散在结节3个月。否认外伤史但爱好热带鱼养殖。体检双手指间关节伸侧散在暗红色黄豆大结节。实验室检查：3例皮损组织反复真菌学检查均为阴性。组织病理提示混合炎症细胞浸润的感染性肉芽肿改变。结核菌素纯蛋白衍生物（PPD）试验均为阳性。例1和例2活检组织分离出海分枝杆菌，例3分枝杆菌培养阴性。3例均诊断为游泳池肉芽肿。分别给予利福平和克拉霉素为主的抗非典型分枝杆菌治疗，1—3个月后皮损完全消退，总疗程2～5个月不等。停药后随访3—12个月均无复发。

Three cases of swimming pool granuloma are reported. Case 1： a 40-year-old female presented with a 2-month history of nodules and plaques on the right hand and forearm. She was a tropical fish salesperson but denied trauma history. Skin examination revealed multiple irregularly sized, dark-red nodules and plaques on the joints of right fingers, wrist, and elbow, as well as multiple subcutaneous nodules simulating strings of beads on the right upper limb. Case 2： a 48-year-old female presented with a 2-month history of nodules and plaques on the left hand and forearm. There was a history of trauma due to tropical fish tank and filter cleaning. Physical examination showed multiple deep purple plaques and painless subcutaneous nodules scattered on the left hand, wrist, and upper limb. Case 3： a 39-year-old male presented with a 3-month history of nodules on the fingers of both hands. There was no history of trauma, but he was a tropical aquarist. Skin examination revealed multiple soybean-sized dark-red nodules on the extensor aspect of interphalangeal joints of both hands. Fungal examinations yielded negative results in the 3 cases, while histopathology revealed infectious granuloma with a mixed inflammatory cell infiltrate. All of the cases showed positive results in purified protein derivative （PPD） skin test. Mycobaeterium marinum was isolated from the lesional tissue of Case 1 and 2, but not from Case 3. All the patients were diagnosed with swimming pool granuloma, and given anti-atypical mycobacterial therapy including oral rifampin and clarithromycin. The lesions disappeared after 1 to 3 months of treatment, with the treatment course varying from 2 to 5 months. No recurrence was observed during a 3- to 12-month follow-up.