播散性快生长分枝杆菌感染1例

A case of disseminated infection by rapidly growing Mycobacteria

目的探讨播散性快生长分枝杆菌感染的临床特征、诊断和治疗。方法对1例播散性快生长分枝杆菌感染进行分析。结果患者为49岁男性,既往无基础病。以间断发热、慢性淋巴结炎和反应性皮疹为主要表现。淋巴结活检组织培养为快生长分枝杆菌,分枝杆菌基因芯片菌种鉴定为龟或脓肿分枝杆菌。诊断为播散性快生长分枝杆菌感染,给予克拉霉素、左氧氟沙星、乙胺丁醇(12个月)、阿莫西林-克拉维酸(3个月)、亚胺培南(4周)治疗18个月,停药后随访3个月仍病情稳定。结论播散性快生长分枝杆菌感染为罕见疾病,多表现为发热、皮下结节或脓肿、淋巴结炎以及内脏受累。诊断主要依据血培养、组织培养和组织病理。

Objective To investigate the clinical feature, diagnosis and treatment of disseminated infection by rapidly growing Mycobcteria （ RGM ）. Methods Analysis was made upon a case of disseminated infection due to RGM. Results This 49 years old male patient had no underlying diseases. He presented with fever, chronic bilat- eral cervical lymphadenopathy and reactive dermatitis. The lymph node biopsy specimen was culture-positive for RGM which was identified as Mycobacterium chelonae/abseessus by gene chip assay. Disseminated RGM infection was diagnosed. This patient was treated with clarithromycin, levofloxaein, ethambutol （12 months） , amoxicillin- clavulanate （3 months） and imipenem （4 weeks） for 18 months. He was really doing well while follow up after discontinuation of treatment for 3 months. Conclusions Disseminated RGM infection is a rare disease, often presents fever, multiple draining subcutaneous nodules or abscesses, lymphadenopathy and organs involvement. Isolation of the organism from culture of blood, aspirated material, or tissue biopsy is the key to diagnose the specific RGM infection.