扁桃体放线菌病误诊10例

Misdiagnosis of tonsil actinomycosis in 10 patients

目的通过病例报道和文献复习探讨扁桃体放线菌病的临床和病理特点,提高临床和病理医师对本病的认识。方法回顾分析本院2005~2015年经术后病理确诊的扁桃体放线菌病10例资料。术前均存在误诊现象,其中术前诊断为慢性扁桃体炎5例、扁桃体囊肿2例、慢性扁桃体炎伴扁桃体息肉3例。均在全身麻醉下行扁桃体切除术,其中5例双侧切除、5例单侧切除(误诊为扁桃体囊肿和息肉者)。围术期均给予青霉素类药物静脉抗感染治疗5~7 d。对误诊情况进行报道和分析并复习相关文献。结果所有病例的临床表现无特异性,术前均误诊为其他扁桃体疾病,均经术后病理检查而确诊。本病采用手术切除扁桃体+青霉素类药物治疗效果佳。结论扁桃体放线菌病临床表现无特异性,且发病率低、误诊率高。为提高诊断水平,需要重视和加强对放线菌病的学习与研究,开阔诊断思路,避免误诊。

Objective To explore the clinical and pathological characteristics of tonsil actinomycosis through the case reports and literature review, thus to raise the awareness of the disease for clinicians and pathologists. Methods Ten cases of tonsil actinomycosis from 2005 to 2015 were retrospectively analyzed. They were misdiagnosed as chronic tonsillitis in 5 cases, as tonsil cyst in 2 cases and chronic tonsillitis with tonsil polyps in 3 cases. Results All the cases were lack of characteristic clinical manifestations and were all misdiagnosed before the surgery. They were confirmed by pathological examination at last. Surgical removal of the tonsils combined with penicillin drugs was effective. Conclusions Lacking characteristic clinical manifestations and low incidence, the misdiagnosis rate of tonsil actinomycosis was high. Clinicians and pathologists need to pay more attention and strengthen to the study and research of actinomycosis to improve the diagnosis accuracy.