游泳池肉芽肿56例临床病理分析

Clinicopathological analysis of 56 cases of swimming pool granuloma

目的探讨游泳池肉芽肿的临床病理特征。方法回顾性分析2018年1月至2021年1月天津市中医药研究院附属医院56例游泳池肉芽肿的临床及病理特点。结果56例患者中,男16例,女40例,平均年龄60.84岁。水产从业人员及居民日常烹饪中处理受感染的鱼或海产品是本组病例感染的主要暴露方式(31/56),平均潜伏期4.58周,平均诊断时间为3.19个月;56例患者皮损均位于上肢,以红斑、丘疹结节为主,有时表现为脓疱、溃疡、肉芽肿或疣状斑块。单发孤立性皮损11例,36例表现为孢子丝菌病串珠样皮损,6例表现为双侧串珠样皮损。组织病理学上除4例无特异性改变外,52例患者表现为感染性肉芽肿,其中37例出现特征性的渗出坏死,中央为不等量的纤维素样渗出或坏死物,其内或周边伴随大量中性粒细胞、组织细胞及多核巨细胞浸润。56例病原微生物宏基因组DNA测序均检测到海分枝杆菌序列。结论天津地区游泳池肉芽肿以老年女性患病为主,处理受感染的鱼或海产品是最主要的暴露方式,组织病理可表现为特征性的渗出坏死性肉芽肿。

Objective To investigate clinicopathological features of swimming pool granuloma.Methods From January 2018 to January 2021,56 patients with swimming pool granuloma were collected from Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital,and their clinical and pathological characteristics were retrospectively analyzed.Results Among the 56 patients,16 were males and 40 were females,with an average age of 60.84 years.The most common exposure type among these patients was handling of infected fishes or seafood by aquaculture workers and residents in daily cooking(31/56),with the average incubation period being 4.58 weeks and average time to diagnosis being 3.19 months.All skin lesions were located at the upper extremities,mainly manifesting as erythema and papular nodules,and sometimes as pustules,ulcers,granulomas or verrucous plaques.Eleven patients presented with solitary skin lesions,36 with sporotrichoid skin lesions,and 6 with bilateral sporotrichoid lesions.Histopathologically,infectious granulomas were observed in all patients except 4 without specific changes,and 37 presented with characteristic exudative necrosis,with varying amounts of fibrinoid exudative or necrotic elements in the center,and a large number of neutrophils,histiocytes and multinucleated giant cells infiltrating or surrounding it.Sequences of Mycobacterium marinum were identified in all 56 cases by metagenomic DNA sequencing of pathogenic microorganisms.Conclusion In Tianjin area,swimming pool granulomas mostly affects elderly females,handling of infected fishes or seafood is the main type of exposure,and skin lesions are histopathologically characterized by exudative necrotic granulomas.