皮肤巴西奴卡菌病6例

Six cases of cutaneous Nocardia brasiliensis

报告6例皮肤巴西奴卡菌感染。例1.患者男,67岁。右下肢结节、脓肿、溃疡3个月余。皮肤科检查:右膝内侧红斑、皮肤破溃、皮下结节。右足背红斑、丘疹,部分破溃,伴渗液、流脓,局部肿胀。例2.患者男,20岁。左小腿红肿伴疼痛2 d。皮肤科检查:左小腿线状红斑、皮下结节,下1/3段可见一约鹌鹑蛋大暗红色结节,中央皮肤破溃,表面可见黄白色脓性分泌物,破溃周边可见数个粟粒大脓疱,压痛明显。例3.患者女,45岁。左上肢红肿伴疼痛9 d,加重1 d。皮肤科检查:左手食指一约1 cm×0.5 cm的伤口,伤口表面覆盖脓性分泌物及坏死组织,左手背及整个左上肢大片水肿性红斑,表面可见隆起性条索状及核桃大包块,压痛明显。例4.患者女,55岁。右踝部前侧皮肤红肿疼痛7d。皮肤科检查:右踝部前侧一直径约1.5 cm的皮肤溃烂面,创面有少许脓性分泌物,腘窝内侧及腹股沟淋巴结区有压痛,皮下多个小结节。例5.患者男,72岁。左手背包块20 d,左手背、前臂红肿、渗出伴疼痛3 d。皮肤科检查:左手背、左臂大片水肿性红斑,表面可见隆起性条索状线性分布的蚕豆至核桃大包块,压痛明显。例6.患者男,49岁。左足背红肿伴疼痛3 d。皮肤科检查:左足背内侧一约鹌鹑蛋大红斑,中央一黄白色脓点,伴大量黄白色脓性分泌物流出,压痛明显。6例患者取皮损处脓液培养均鉴定为巴西奴卡菌感染,诊断为皮肤巴西奴卡菌感染。除1例患者因磺胺过敏外,其余5例患者在使用复方磺胺甲噁唑联合其他抗生素治疗后,均预后良好。

Six cases of skin infection with Nocardia brasiliensis are reported.Case 1.The patient was a 67-year-old male.Nodules,abscesses and ulcers of the right lower extremity lasted more than three months.Dermatological examination showed erythema,skin ulceration,subcutaneous nodules of the right knee.Erythema and papule of the right dorsal foot,partial ulceration,drainage,pus,local swelling.Case 2.The patient was a 20-year-old male.Red,swollen left calf with pain lasted for two days.Dermatological examination showed linear erythema and subcutaneous nodules on the left calf.Dark red nodules about the size of quail eggs were seen in the lower 1/3 segment The central skin ruptured,and yellow and white purulent secretions were seen on the suface.Case3.The patient was a 45-year-old female.Red and swollen left upper limb with pain lasted for nine days aggravated for 1 day.Dermatological examination showed a wound about 1cmx05cm on the left index finger.The wound surface was covered with purulent secretions and necrotic tissue,the back of the left hand and the entire left upper limb were large edematous erythema,the surface of the raised cord and walnut mass were visible,the tenderness was obvious.Case 4.The patient was a 55-year-old female,Red,swollen and painful skin on the anterior side of the right ankle lasted for more than seven days.Dermatological examination showed a skin ulcerative surface about 1.5cm in diameter on the anterior side of the right ankle,a litle purulent secretion on the wound,tenderness in the medial popliteal fossa and inguinal lymph node area,and multiple small nodules under the skin.Case 5.The patient was a 72-year-old male.Left hand backpack block lasted for 20 days,left back,forearm redness,swelling,exudation with pain lasted for three days.Dermatological examination showed large edematous erythema on the back and left arm of the left hand.The surface raised linear distribution of broad bean to walnut large and small clumps,and the tendemess was obvious.Case6.The patient was a 49-year-old male Red swelling of left dorsal foot with pain lasted for there days.Dermatological examination showed a quail egg sized erythema on the medial dorsum of the left foot,a yllowish-white pus spot in the center,accompanied by a large amount of yellowish-white purulent discharge,and obvious tenderness.Pus from the skin lesions of all six cases of skin lesions was cultured Nocardia brasiliensis infection was detected.Except for one patient who was allergic to sulfanilamide,the remaining five patients had a good prognosis after treatment with sulfamethoxazole combined with other antibiotics.