Moergel M, Walter C, Coerdt W, Reichert T E, Kunkel M
Klinik für Mund-, Kiefer- und Gesichtschirurgie, Johannes-Gutenberg-Universität Mainz.
Mund Kiefer Gesichtschir. 2004 Sep;8(5):311-5. doi: 10.1007/s10006-004-0562-8. Epub 2004 Jul 29.
Cutaneous lesions of atypical mycobacteriosis are very rare in Western Europe. Both the slow disease progression and the rather unspecific clinical appearance of the chronic infiltration render cutaneous mycobacteriosis a diagnostic challenge. In this communication, we present an uncommon, biphasic course of a cutaneous atypical mycobacteriosis.
A 3-year-old child was referred to our institution due to submandibular cutaneous infiltration together with subcutaneous abscess formation. There was no carious lesion or other odontogenic potential source of infection. First-line therapy was incision of the abscess and local curettage to obtain a specimen for histologic and microbiologic evaluation, which revealed atypical mycobacteria. In spite of local curettage, only partial remission of the cutaneous infiltration was achieved. When the child was readmitted 9 months later, the lesion had progressed to a scrofulosis-like appearance even though specific antibiotic treatment had been administered. Complete surgical excision of the affected skin and extirpation of the respective lymph node and fistula was performed as second-line therapy. Complete remission was achieved without further adjuvant treatment.
Our case demonstrates the problems that may arise with this rare type of mycobacterial infection. In all probability, scratch artifacts due to atopic dermatitis provided the source/entry of the infection in this specific case. Both histopathologic findings and clinical appearance were suggestive of classic cutaneous tuberculosis (tuberculosis cutis colliquativa), although it was in fact an atypical mycobacteriosis. Furthermore, obstinate persistence after minor surgical intervention and even after specific (triple) antibiotic treatment illustrates the difficulties of limited, minimally invasive treatment.
非典型分枝杆菌病的皮肤病变在西欧非常罕见。慢性浸润的疾病进展缓慢且临床表现相当不特异，这使得皮肤分枝杆菌病成为一项诊断挑战。在本报告中，我们呈现了一例皮肤非典型分枝杆菌病罕见的双相病程。
一名3岁儿童因下颌下皮肤浸润伴皮下脓肿形成被转诊至我院。无龋损病变或其他牙源性潜在感染源。一线治疗是切开脓肿并局部刮除，以获取标本进行组织学和微生物学评估，结果显示为非典型分枝杆菌。尽管进行了局部刮除，但皮肤浸润仅部分缓解。9个月后患儿再次入院时，尽管已给予特异性抗生素治疗，病变仍进展为瘰疬样外观。作为二线治疗，对受累皮肤进行了完整的手术切除，并切除了相应的淋巴结和瘘管。未进行进一步辅助治疗即实现了完全缓解。
我们的病例展示了这种罕见类型的分枝杆菌感染可能出现的问题。在这个特定病例中，特应性皮炎引起的搔抓痕迹很可能是感染的来源/入口。组织病理学发现和临床表现均提示为经典的皮肤结核（液化性皮肤结核），尽管实际上是一种非典型分枝杆菌病。此外，在小手术干预后甚至在特异性（三联）抗生素治疗后仍顽固持续，说明了有限的微创治疗的困难。
