海分枝杆菌感染误诊为坏疽性脓皮病报告1例

Mycobacterium marinum infection misdiagnosed as pyoderma gangrenosum:one case report

68岁男性患者无明显诱因出现右腕背处多发无痛性黄豆大小红斑、丘疹,蔓延至上臂1年余,于外院诊断为坏疽性脓皮病等,并给予免疫抑制治疗;3个月前,右上肢红斑及疼痛加剧,伴破溃,某院皮肤损伤组织病理检测提示符合慢性肉芽肿性炎症,宏基因组二代测序(mNGS)检出海分枝杆菌,故确诊为海分枝杆菌感染。本文就该例海分枝杆菌感染病例进行报告,旨在提高临床对海分枝杆菌感染的认识,做到早诊断、早治疗,改善患者预后。

A 68-year-old male patient developed multiple painless soybean-sized erythema and papules on the back of the right wrist,and spread to the upper arm without obvious inducement for more than 1 year.Pyoderma gangrenosum was diagnosed at another hospital and immunosuppressive treatment was applied.Erythema and pain in the right upper extremity aggravated with ulceration 3 months ago.Histopathological detection of the lesion in a hospital suggested consistence with chronic granulomatous inflammation,and metagenomic next-generation sequencing(mNGS)of the lesion tissue indicated Mycobacterium marinum.Therefore,the patient was diagnosed as Mycobacterium marinum infection.This article reports the case with Mycobacterium marinum infection,aiming to improve the clinical understanding on Mycobacterium marinum infection,achieve early diagnosis and treatment,and improve patient prognosis.