粗糙型脓肿分枝杆菌致播散性皮肤感染

A case of disseminated cutaneous infection of Mycobacterium abscessus

报告1例少见的播散性粗糙型脓肿分枝杆菌皮肤感染。患者女,16岁。因四肢播散性红斑、结节,伴反复发热、盗汗及淋巴结增大就诊。皮肤科检查:四肢散在数个暗红色斑,可触及蚕豆至鹌鹑蛋大皮下结节;左膝关节一4 cm×3 cm溃疡面。实验室及辅助检查:血常规中WBC及血红蛋白均下降;左膝关节溃疡分泌物涂片:抗酸染色阳性(++);血平皿培养:表现为粗糙型菌落形态;16S rRNA基因和RNA聚合酶β亚单位rpoB基因序列测定提示为脓肿分枝杆菌。诊断:播散性粗糙型脓肿分枝杆菌皮肤感染。予静脉滴注丁胺卡那霉素及口服克拉霉素治疗1年后痊愈。

A rare case of disseminated cutaneous infection by Mycobacterium abscessus is reported. A 16-year-old girl pre sented with cutaneous erythemas and nodules on the limbs with recurrent fever, night sweats and enlarged lymph nodes. Physical examination showed cutaneous erythemas and pigeon-egg-sized subcutaneous nodules on her limbs and a 3 cm ～ 4 cm ul- cer on the left knee. Laboratory examination showed reductions in both WBC and hemoglobin. Smears of ulcer discharge showed acid-fast bacillus positive （＋＋）. Blood cultures displayed a rough morphotype. 16S rRNA and rpoB gene sequencing analysis confirmed Mycobacterium abscessus as the pathogen. The diagnosis was disseminated cutaneous infection by Mycobacterium abscessus. Patient was cured after one-year treatment with intravenous injection of amikacin and oral clarithromycin.