Domfeh Akosua B, Nodit Laurentia, Gradowski Joel F, Bastacky Sheldon
Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, and University of Alabama, Birmingham, Alabama 15213, USA.
Acta Cytol. 2007 Jul-Aug;51(4):627-30. doi: 10.1159/000325813.
Identification of disseminated nontuberculous Mycobacterium infection is a challenge, especially when it occurs in patients without a known cause of immunosuppression. Acid-fast organisms in the pleural fluid are rare and easily missed, especially when they occur in patients without a clinical suspicion of infection. The classical cytologic picture of tuberculous pleural fluid with lymphocytosis and paucity of mesothelial cells is not seen.
A 57-year-old man presented with chronic neutrophilia of unknown etiology together with chest pain and bilateral pleural effusions. Pleural fluid cytology revealed organisms seen in the cytoplasm of numerous macrophages and neutrophils, creating a "negative image" on Diff-Quik smears. Acid-fast stains demonstrated intracellular acid-fast bacilli consistent with mycobacteria. Microbiologic studies with DNA probe technology resulted in identification of the mycobacterial organism as Mycobacterium kansasii.
Nontuberculous Mycobacterium should be included in the differential diagnosis in patients with inflammatory, exudative pleural effusions.
识别播散性非结核分枝杆菌感染具有挑战性，尤其是当它发生在无已知免疫抑制病因的患者中时。胸腔积液中的抗酸菌很少见且容易漏检，特别是当它们出现在无临床感染怀疑的患者中时。未见到结核性胸腔积液中淋巴细胞增多和间皮细胞稀少的典型细胞学表现。
一名57岁男性因病因不明的慢性嗜中性粒细胞增多症伴胸痛和双侧胸腔积液就诊。胸腔积液细胞学检查显示在众多巨噬细胞和中性粒细胞的细胞质中可见微生物，在Diff-Quik涂片上形成“负像”。抗酸染色显示细胞内抗酸杆菌，与分枝杆菌一致。采用DNA探针技术的微生物学研究确定该分枝杆菌为堪萨斯分枝杆菌。
对于有炎症性、渗出性胸腔积液的患者，鉴别诊断应包括非结核分枝杆菌。
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