猫抓病15例临床病理特征

Clinicopathologic characteristics in 15 cases of cat-scratch disease

目的 探讨猫抓病(CSD)临床病理特征、病因及诊断要点,以提高对CSD的认识,减少漏诊和误诊。方法回顾我院1986～1999年间所收集的15例猫抓病患者淋巴结活检资料,对其进行临床病理分析。结果 15例猫抓病患者均有与猫密切接触史;临床表现以自限性局部(颈部7例,腋下8例,肘部3例)淋巴结肿大为主,沿淋巴引流方向规律分布;HE镜下病理学特点为淋巴结内坏死性肉芽样微脓肿形成;特殊染色显示血管壁及微脓肿中革兰氏阴性、嗜银性、不耐酸的多形性杆菌存在。结论 CSD是一种病程自限的细菌感染性疾病,临床特征和淋巴结活检病理特点辅以Warthin-Starry银染色对其诊断及鉴别诊断具有重要意义。

[Abstract] Objective To investigate the clinicopathologic characteristics, etiology and diagnosis ofcat-scratch disease(CSD), so that to increase one's knowledge of CSD and decrease the rate of misdiagnosis. Methods Fifteen cases of CSD from 1986 - 1999 were studied by means of clincopathologic analysis and lymph node biopsy with HE histological sections and special stainings including Warthin-Starry argentation, Brown-Hopp Gram's method and antacid stain (Ziehl-neelsen method) . All these sections were observed under a light microscope in contrast to positive section. Results In most cases there was a history of contact (15/15) , scratch or bite (13/15) by a cat or other animal, only two of them had been punctured by foreign bodies. The main clinical manifestation was self-limiting local tumefaction involving cervical (7 cases), axillary (8 cases)and cubital (3 cases) lymph nodes which were distributed regularly along the region of lymphatic return and the pathological feature in HE was the appearance of necrotizing granulomatous microabscess in lymph nodes section. Special staining exhibited the existence of gram-nagtive, argentaffin, non-acid-resistant and pleomorphic bacilli in the vascular wall and microabscess. Conclusion The results show that CSD is a self-limiting disease caused by bacterial infection. Clinical characteristics and pathological features in lymph node biops with Warthin-Starry argentation have important significance in its diagnosis and differentiation.