龟分枝杆菌皮肤感染一例  

Cutaneous Mycobacterium chelonae infection： a case report

作　　者：张忠奎[1] 王春梅[1] 刘太华[1] 陈易华[2] 曾平[3] 王骏[1] 周舟[1] 何思娴 唐丽娟[1] 康道现[4] 冉玉平[4] 

机构地区：[1]成都军区总医院皮肤科,610083 [2]成都军区总医院病理科,610083 [3]成都军区总医院检验科,610083 [4]四川大学华西医院皮肤性病科

出　　处：《中华皮肤科杂志》2013年第11期829-831,共3页Chinese Journal of Dermatology

摘　　要：患者女，69岁，因右小腿红肿、结节、溃疡伴疼痛5个月，加重1个月就诊。皮肤科检查：右小腿轻度肿胀，右膝关节以下可见10余个大小不等明显高出皮面的暗红色结节、溃疡，渗出暗红色液体，质软，压痛明显。实验室检查：创面分泌物沙氏葡萄糖琼脂培养基培养出光滑、湿润、不产色白色菌落，抗酸染色示阳性杆菌。PCR扩增16SrRNA基因产物与龟分枝杆菌AB548610．1同源性达100％。皮损组织病理检查：皮下组织慢性化脓性炎症，抗酸染色示阳性杆菌，过碘酸雪夫染色阴性。诊断：龟分枝杆菌皮肤感染。经静脉滴注亚胺培南一西司他丁500mg每日3次，口服复方磺胺甲嗯唑4片每日3次，治疗好转出院。] A 69-year-old female presented with erythematous swelling, tender nodules and ulcer in the right leg for five months, which had been aggravated for one month. Dermatological examination revealed a mild swelling of the right lower extremity, and more than ten dull red, elevated, tender and soft ulcerative nodules with bloody fluid exudates below the right knee. Culture of the bloody exudate on Sabouraud＇s dextrose agar grew smooth, wet and non-color-producing white colony, which was confirmed as an acid-fast bacillus. There was a 100% homology in the sequence of 16S rRNA between the bacillus isolate and Mycohactedum chelonae type strain （Genebank accession number AB548610.1）. Pathological study revealed a chronic purulent inflammation of subcutaneous tissue, which was positive for acid-fast staining, hut negative for periodic acid-Schiff staining. A diagnosis of cutaneous Mycohacterium chelonae infection was made. The condition was improved and the patient was discharged after treatment with imipenem-cilastatin 500 mg thrice daily and compound sulphamethoxazole four tablets thrice daily.

关 键 词：龟分枝杆菌 皮肤感染 16SrRNA 慢性化脓性炎症 过碘酸雪夫染色 琼脂培养基 组织病理检查 抗酸染色 

分 类 号：R754[医药卫生—皮肤病学与性病学]