中间界线类麻风误诊1例

Misdiagnosis of Intermediate Borderline Leprosy:A Case Report

患者男,36岁。泛发无症状的大小不一暗紫红色丘疹、结节。多次多部位组织液麻风杆菌抗酸染色均为阴性。皮损组织病理检查示:真皮网状层全层见片状、带状淋巴组织细胞浸润,中央以组织细胞为主,胞浆丰富,部分胞浆泡沫化,周围围绕较多淋巴细胞。皮损组织抗酸染色示:阳性。免疫组织化学染色示:CD1a、CD3、CD4、CD5、CD8、CD56、CD68、CD79a、S100(不同程度+)、Langerin、CD7、CD30、CD38、CD123、MCT(-)。麻风杆菌核酸检测示:阳性。诊断:中间界线类(BB)麻风。治疗:因氨苯砜综合征易感基因HLA_B1301检查阳性,不建议服用氨苯砜,予以利福平600 mg,1次/月;克拉霉素500 mg,1次/月;氯法齐明300 mg,1次/月,外加氯法齐明50 mg,1次/d联合化疗。随诊9个月,患者全身红斑消退,丘疹、结节明显缩小,数量减少。

A 36-year-old male presented with generalized asymptomatic dark purplish-red papules and nodules of various sizes.Multiple acid fast staining experiments of tissue fluids from multiple sites were negative for Mycobacterium leprae.Histopathological examination of the skin lesions showed that the whole layer of the dermal reticular layer was infiltrated by flaky and banded lymphoid tissue cells,with histiocytes dominating in the center,rich in cytoplasm,part of the cytoplasm was foamy,and surrounded by a large number of lymphocytes.Skin lesion tissue showed positive acid fast staining.Immunohistochemical staining showed:CD1a,CD3,CD4,CD5,CD8,CD56,CD68,CD79a,S100(varying degrees of+),Langerin,CD7,CD30,CD38,CD123,MCT(-).The nucleic acid test for Mycobacterium leprae showed:positive.Diagnosis:intermediate borderline category(BB)leprosy.Treatment:Due to the positive test of HLA_B1301,the susceptibility gene of Dapsone syndrome,dapsone was not recommended;rifampicin 600 mg,once a month;clarithromycin 500 mg,once a month;clofazimine 300 mg,once a month,plus clofazimine 50 mg,once a day combined with chemotherapy.After a 9-month follow-up,the patient′s erythema has regressed,and papules and nodules were significantly reduced in size and quantity.