中华皮肤科杂志 ›› 2007, Vol. 40 ›› Issue (4): 206-209.

• 论著 • 上一篇    下一篇

脓肿分枝杆菌致全身播散性皮肤感染一例

王洪生, 靳培英, 吴勤学   

  1. 中国医学科学院、中国协和医科大学皮肤病研究所, 南京, 210042
  • 收稿日期:2006-05-12 出版日期:2007-04-15 发布日期:2007-04-15
  • 通讯作者: 吴勤学,email: E-mail:wuqx2003@hotmail.com

A case of disseminated cutaneous infection with Mycobacterium abscessus

WANG Hong-sheng, JIN Pei-ying, WU Qin-xue   

  1. Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing 210442, China
  • Received:2006-05-12 Online:2007-04-15 Published:2007-04-15

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摘要： 目的 报道1例罕见的全身播散性脓肿分枝杆菌皮肤感染.方法 对患者作全面临床检查.应用流式细胞仪检测患者细胞免疫水平,同时进行组织病理检查、组织培养.用PCR-RFIJP、基因测序方法对分离自患者皮损的分枝杆菌做鉴定.结果 患者女,22岁,1年多前,无明显诱因面颈部出现对称性红斑,并在此基础上渐出现丘疹、结节和斑块,逐渐扩展至躯干四肢;患者CD4+T细胞低于正常,HIV抗体检测阴性.对皮损进行两次多管体外培养,3～5天后,Löwenstein-Jensen培养基上(37℃和32℃)出现阳性菌落.PCR-RFLP比较分析发现,临床分离株的酶切(BstEⅡ和HaeⅢ)图谱与脓肿分枝杆菌的酶切图谱相符合;对临床分离株的hsp65、16S rRNA基因进行了序列分析,发现该二序列与脓肿分枝杆菌同源性最接近,分别是99.75%和100%.予以患者口服利福平、异烟肼、左氧氟沙星、克拉霉素,胸腺肽肌内注射,2个月后皮损明显好转.复查该患者的免疫状况,CD4+T细胞已在正常范围;6个月后颈部、躯干及四肢皮损基本痊愈.结论 结合表型特征、DNA酶切图谱和序列分析,临床分离株符合脓肿分枝杆菌;抗生素联合化疗辅以免疫调节剂综合治疗有效.

关键词: 分枝杆菌属, 分枝杆菌感染

Abstract: Objective To report an unusual case of disseminated cutaneous infection with Mycobacterium abscesses.Methods A complete clinical examination was performed for this patient.Flow cytomerry was used to measure the cellular immunity level of the patient.Tissue samples were obtained from the skin lesions,and subjected to acid-fast staining,histopathological examination and mycobacterium culture.PCR-restriction' fragment length polymorphism(RFLP) analysis of hsp65 gene with endonucleases BstE Ⅱ and Hae Ⅲ,and gene sequencing of hsp65 and 16sRNA genes,were applied to identify the isolate from skin lesions of the patient.Results The patient was a 22 years old female with disseminated cutaneous infection.The lesions began as symmetrical inflammatory erythema on the face and neck 1 year ago without obvi ous inducements,and gradually developed into small papules,nodules and erythematous infiltrated plaque,which then spread to the trunk and extremities.Flow cytometry revealed that her CD4+ lymphocyte count was lower than normal.The patient was negative for HIV antibody.Mycobacterium colonies was seen to grow on Lowenstein-Jensen(L-J) medium after two times of multiple-tubes culture at 37℃and 32℃ for 3-5 days.PCR-RFLP showed that the restriction endonuclease pattern of the clinical isolate was consistent with that of M.abscesses.Gene sequencing revealed a homology of 99.75% and 100% in hsp65 and 16SrRNA gene respectively between the isolate and M.abscesses.After two months of treatment with rifampin,isoniazid,levofloxacin,clarithromycin and thymosin,the lesions markedly resolved and CD4+ T cell count rose to normal level.Six months later,nearly all the lesions on the neck,trunk and extremities resolved with pigmented macules and atrophic scar left.Conclusions The clinical isolate is confirmed to be M.abscesses by phenotype,restriction endonuclease pattern and gene sequencing.Therapeutic efficiency could be achieved with antibiotics in combination with immunomodulator.

Key words: Mycobacterium, Mycobacterium infections