Ridaura-Sanz Cecilia, López-Corella Eduardo, Salazar-Flores Margarita
Department of Pathology, National Institute of Pediatrics, Mexico City, DF, Mexico.
Fetal Pediatr Pathol. 2006 Mar-Apr;25(2):107-17. doi: 10.1080/15513810600788798.
Super-infection of an exogenous lipoid pneumonia by nontuberculous mycobacteria has been described in the literature. It produces a distinctive histologic picture with suppurative, noncaseating granulomas surrounding lipid vacuoles containing acid-fast bacilli. Mainly isolated cases have been found, but seldom in children. We describe a series of 9 children with similar histological findings. All our patients were under 1 year of age, malnourished, and with chronic respiratory symptoms. The diagnosis, based on the characteristic histology with acid-fast rods, was established at autopsy in 4 cases, on lobectomy specimens in 4 and by open lung biopsy in 1. Mycobacterium fortuitum-chelonei was cultured in 1 case. Gastro-esophageal reflux was documented in all 4 cases in which it was explored. Aspiration of lipid gastric contents or of oil given as medication can result in exogenous lipoid pneumonia, which in turn becomes super-infected with mycobacteria. Recognition of the distinctive histology permits the diagnosis of this complication.
文献中已描述了非结核分枝杆菌对外源性类脂性肺炎的重叠感染。它产生一种独特的组织学表现，有围绕含抗酸杆菌的脂质空泡的化脓性、非干酪样肉芽肿。主要发现的是散发病例，儿童中很少见。我们描述了一组9例具有相似组织学表现的儿童。我们所有的患者均未满1岁，营养不良，并有慢性呼吸道症状。基于抗酸杆菌的特征性组织学表现，4例在尸检时确诊，4例在肺叶切除标本中确诊，1例通过开胸肺活检确诊。1例培养出偶然分枝杆菌-龟分枝杆菌。在所有4例进行检查的病例中均记录到胃食管反流。吸入脂质胃内容物或作为药物给予的油可导致外源性类脂性肺炎，进而被分枝杆菌重叠感染。认识到这种独特的组织学表现有助于诊断这种并发症。
