播散性奴卡菌病一例报道并文献复习

Disseminated Nocardiosis: Case Report and Literature Review

目的总结播散性奴卡菌病的临床特点、诊治方法和误诊原因,以减少临床误诊误治。方法回顾性分析1例播散性奴卡菌病误诊病例资料,并复习相关文献。结果患者44岁女性,因发热、多发皮肤肿块、腰背部疼痛10 d就诊,病初外院考虑肺部感染性疾病给予抗感染治疗,后病情进展遂来我院。院外长期服用糖皮质激素,入我院后查血多项炎性指标异常,患有糖尿病,影像学检查显示皮肤、肾脏、腹膜后炎性占位性病变,血培养证实奴卡菌感染。确诊为播散性奴卡菌病(累及血液、皮肤、肾脏、腹膜后),给予联合抗感染及外科手术治疗症状好转,随访未见复发。结论对于长期应用糖皮质激素的免疫功能低下患者出现发热、脓肿等病变时,应高度警惕奴卡菌病,病原学检查是确诊的关键,确诊后应及早使用磺胺类药物或敏感抗生素,必要时应予外科辅助治疗。

Objective To summarize the clinical features of disseminated nocardiosis,methods of diagnosis and treatment as well as causes of misdiagnosis,so as to reduce the misdiagnosis and mistreatment.Methods We restrospectively analyzed the clinical data of one case diagnosed with disseminated nocardiosis and reviewed the related literature.Results A 44-year-old female presented to our hospital with a history of fever,multiple skin masses and backache for 10 days.The patient was initially diagnosed as having pulmonary infection in another hospital,which was treated with antibiotics,but gradually aggravated.Thus,the patient was treated with long-term steroids before diagnosis of nocardiosis.Laboratory studies showed abnormal inflammatory indicators and diabetes.Radiological findings showed inflammatory lesions in the skin,kidney and retroperitoneum.Nocardia infection was confirmed by blood culture tests.The patient was finally diagnosed as having disseminated nocardiosis(affecting blood,skin,kidneys and retroperitoneum),who recovered after the combined treatment of antibiotics and surgical procedures.At the follow-up,no recurrence was reported.Conclusion For immunocompromised patients treated with long-term steroids,nocardiosis should be suspected when they have fever,especially accompanied with abscess lesions.Etiological examination is the key to diagnosis of this disease.Timely use of sulfonamides or sensitive drugs is important,and adjuvant surgical procedures are likely to be necessary.