免疫抑制治疗患者罹患皮肤非结核分枝杆菌感染二例

Cutaneous nontuberculous Mycobacterium infection occurred in two patients udergoing immunosuppressive treatment

患者1,皮肤多处结节、溃疡伴发热1个月余,皮损组织病理提示感染性肉芽肿,分子生物学检查为嗜血分枝杆菌感染,予环丙沙星、克拉霉素、异烟肼治疗1年后治愈,该患者2016年诊断为系统性红斑狼疮、Ⅵ型狼疮性肾炎,予腹膜透析、糖皮质激素及免疫抑制剂长期治疗。患者2,双下肢溃疡伴疼痛3个月,皮损组织病理提示感染性肉芽肿,分子生物学检查为鸟分枝杆菌感染,未治疗。3个月后复诊,病情加重,予乙胺丁醇、克拉霉素、利福平治疗,目前正在随访中。该患者7年前因“慢性肾衰竭”行同种异体肾移植术,术后规律服用他克莫司胶囊、吗替麦考酚酯片、糖皮质激素。对于长期应用免疫抑制剂和糖皮质激素的患者出现皮肤结节、脓肿和溃疡时,应考虑到皮肤NTM感染的可能。

One case presented with multiple nodules and ulcers with fever for 1 month.Biopsy showed infectious granuloma and Haemophilus was indentified by PCR,the patient was cured after treated with ciprofloxacin,clarithromycin and isoniazid for 1 year.This patient suffurred from systemic lupus erythematosus and lupus nephritis from 2016 and given the therapy of peritoneal dialysis,oral glucocorticoids and immunosuppressants.Another case presented with ulcers on lower extremity with pain for 3 months,biopsy showed infectious granuloma and Mycobacterium Avium was indentified by PCR,the patient refused treatment.However,the patient s condition worsened at the patient s return visit after 3 months.We treated the patient with ethambutol,clarithromycin,rifampicin and the patient is under follow-up.This patient had a history of kidney transplantation for chronic renal failure 7 years ago and regular use of tacrolimus capsule,metecocorticoid tablet,glucocorticoid.Skin nodules,abscesses,and ulcers in patients with prolonged use of immunosuppressant and glucocorticoid should be considered NTM infection.