误诊为孢子丝菌病的皮肤海分枝杆菌感染1例

Cutaneous Infection by Mycobacterium Marinum Misdiagnosed as Sporotrichosis:A Case Report

患者男,48岁,右上肢多发性结节、斑块2年余,曾多次在外院及本院诊断为孢子丝菌病,抗真菌治疗无效,且病情逐渐加重。皮肤科情况:右手无名指指关节伸侧至前臂呈淋巴管型排列的散在或聚集分布10余个直径为1~2 cm暗红色结节、斑块,部分破溃伴脓性分泌物。皮损组织病理示:感染性肉芽肿。脓液真菌培养阴性,分枝杆菌培养见菌落生长,测序结果鉴定为海分枝杆菌。诊断:皮肤海分枝杆菌感染。给予口服克拉霉素、盐酸左氧氟沙星、利福平等药物治疗,皮损明显消退,仍在随访中。

A 48-year-old male presented with multiple nodules and plaques on the right upper limb for more than 2 years.He was diagnosed as sporotrichosis in other hospitals and our hospital for many times.The antifungal treatment was ineffective,and the disease gradually worsened.Dermatological conditions showed more than 10 dark red nodules and plaques with diameters ranging from 1 to 2 cm were scattered or clustered from the extended side of the knuckle of the right ring finger to the forearm in a lymphatic arrangement,some of which were ruptured with purulent secretions.Histopathological examination of the skin lesion showed infectious granuloma.Fungal culture of pus was negative,and mycobacterial culture showed bacteria colony growth,which was identified as Mycobacterium marine by sequencing.Diagnosis:Cutaneous infection by Mycobacterium marinum.Oral clarithromycin,levofloxacin hydrochloride and rifampican were prescribed for combined treatment.Up to this report,the skin lesions obtained obvious improvement and this case still in follow-up.