艾滋病合并胫骨非结核分枝杆菌骨髓炎一例

AIDS complicated with non-tuberculous mycobacterial osteomyelitis of the tibia:a case report

非结核分枝杆菌(NTM)是一种机会致病菌,常发生于免疫抑制人群,NTM骨髓炎是一种罕见的疾病,多数是播散性感染的一部分。该文报道1例艾滋病合并胫骨下段的NTM骨髓炎患者的诊治过程。该例为40岁女性患者,在抗反转录病毒过程中,出现左侧踝关节疼痛入院,结合血培养及影像学,术前诊断为马尔尼菲篮状菌骨髓炎,术后脓液培养NTM阳性,结合病理最终诊断为NTM骨髓炎,予多次手术治疗。术后随访1年余,患者情况良好。该例的诊治过程提示,艾滋病患者出现迅速进展的骨髓炎,应该考虑到NTM骨髓炎的诊断,其诊断依赖于病原体的培养,及时的手术清创和基于药敏试验的抗NTM治疗,对疾病的转归有重要意义。

Non-tuberculous mycobacteria(NTM)are opportunistic pathogens that often infect the immunosuppressed individuals.NTM osteomyelitis is a rare disease,mostly as part of disseminated infection.In this article,the diagnosis and treatment of an AIDS patient complicated with NTM osteomyelitis of the lower tibia were reported.The 40-year-old female patient was admitted due to the left ankle pain during antiretroviral therapy.According to blood culture test and imaging examination,the patient was diagnosed with Talaromyces mareffei osteomyelitis before surgery.Postoperative pus culture was positive for NTM.She was pathologically diagnosed with NTM osteomyelitis.After multiple cycles of surgical treatments and more than 1 year of postoperative follow-up,the patient was physically stable.The diagnosis and treatment of this case prompt that the diagnosis of NTM osteomyelitis should be considered for AIDS patients presenting with rapidly-progressive osteomyelitis.The diagnosis depends on the culture of pathogens.Prompt surgical debridement and anti-NTM treatment based on drug sensitivity test are of significance for elinical prognosis.