瘤型麻风伴梅毒非特异性抗体假阳性1例

A False Positive Case of Nonspecific Antibody Against Tuberous Leprosy with Syphilis

患者男,46岁,面部、四肢、足侧缘斑块、结节2个月,躯干、四肢暗红色斑疹1个月。面部皮损组织病理示:表皮轻度萎缩,真皮内见由泡沫样组织细胞构成的结节状浸润,与表皮间有无浸润带,抗酸菌染色(4+)。足部皮损组织病理示:表皮轻度萎缩,真皮及皮下脂肪组织内见白色泡沫样组织细胞构成的结节状浸润,与表皮间有无浸润带,抗酸菌染色(4+)。躯干部皮损组织病理示:表皮轻度萎缩,真皮血管周围可见组织细胞、淋巴细胞浸润,部分组织细胞呈泡沫状,抗酸菌染色(2+)。面部皮肤组织涂片,抗酸杆菌阳性(4+)。甲苯胺红不加热血清试验(TRUST)阳性,TRUST半定量1∶1,梅毒螺旋体特异性抗体(TPPA)阴性。诊断:瘤型麻风伴梅毒非特异性抗体假阳性。于当地疾控中心接受麻风联合化疗(MDT-MB)方案治疗好转,目前随访中。

A 46-year-old male patient presented with plaques and nodules on the face,limbs and feet for two months,and dark red macules on trunk and limbs for one months.Histopathology of facial skin lesions showed that the epidermis was slightly atrophied,with nodular infiltration formed by foam-like tissue cells in the dermis and no infiltration zone between the epidermis.Acid fast bacteria staining(4+).Histopathology of the skin lesions of the feet showed that the epidermis was slightly atrophied,nodular infiltration composed of white foam-like tissue cells was observed in the dermis and subcutaneous adipose tissue,and there was no infiltration zone between the epidermis.Acid fast bacteria staining(4+).Histopathology of the cadre showed mild epidermal atrophy.The infiltration of histiocytes and lymphocytes can be seen around the dermal vessels.Some of the histiocytes were foamy.The acid-fast bacteria stain(2+).Facial skin tissue smear,positive for acid-fast bacilli(4+).Toluidine red unheated serum test(TRUST)was positive,semi-quantitative TRUST 1∶1,and treponema pallidum specific antibody(TPPA)was negative.Diagnosis:neoplastic leprosy with false positive nonspecific antibody to syphilis.She was treated with MDT-MB in the local center for disease control,and was currently being followed up.