Tapias Leonidas, Tapias-Vargas Luis Felipe, Tapias-Vargas Leonidas
Surgery Department, Fundación Oftalmológica de Santander, Clínica Carlos Ardila Lülle, Floridablanca, Santander, School of Medicine, Universidad Industrial de Santander, Bucaramanga, Colombia.
Int J Dermatol. 2008 Aug;47(8):833-5. doi: 10.1111/j.1365-4632.2008.03656.x.
In May 2004, a 48-year-old male surgeon, resident in Bucaramanga, Colombia, suffered a superficial cut with a scalpel to the lateral aspect of the mid-phalanx of the second finger of the left hand while performing a pulmonary decortication surgical procedure for tuberculous empyema with pulmonary entrapment. The injury healed normally but, approximately 2 weeks after the event, an erythematous, nonpainful papule of approximately 3 mm in diameter developed, and increased progressively to 7 mm 3 days after its initial appearance. At this time, the papule showed spontaneous secretion of a clear liquid and superficial ulceration (Fig. 1). Approximately 3 weeks after the injury, a Gram stain of the liquid was performed; it showed no bacteria but a moderate leukocyte reaction. Because of the high suspicion of possible tuberculous infection, bacilloscopy of the liquid was performed, and was positive (++) for acid-fast bacteria (Fig. 2). The liquid was cultured and grew Mycobacterium tuberculosis. The culture was sent to the Laboratory of Mycobacteria at the National Institute of Health, Bogota, Colombia for drug resistance testing. Susceptibility was demonstrated against streptomycin, isoniazid, rifampicin, and ethambutol. During this time, the patient presented an ipsilateral painful axillary adenopathy of about 2.5 cm in diameter. The patient consulted with an infectologist, who initiated a Directly Observed Therapy Short Course (DOTS) regimen [first phase (8 weeks): daily, except Sundays, streptomycin 1 g intramuscularly, pyrazinamide 1500 mg orally, isoniazid 300 mg, and rifampicin 600 mg; second phase (18 weeks): twice weekly rifampicin 600 mg and isoniazid 500 mg], accompanied by daily pyridoxine to prevent secondary effects from isoniazid. After 3 weeks of treatment, the finger lesion had disappeared. Treatment was undertaken as described above, with the patient reporting symptoms of vertigo, nausea, epigastralgia, and mild myalgia as the adverse effects of medication. A chest x-ray was taken and reported to be normal. The axillary adenopathy disappeared approximately 6 months after the injury. Nearly 3.5 years after the incident, the patient has not presented any type of symptomatology.
2004年5月，一名48岁的男性外科医生，居住在哥伦比亚的布卡拉曼加，在为一名患有结核性脓胸并伴有肺萎陷的患者进行肺纤维板剥脱手术时，左手食指中节指骨外侧被手术刀轻微割伤。伤口正常愈合，但在受伤约2周后，出现了一个直径约3毫米的红色、无痛丘疹，最初出现3天后逐渐增大至7毫米。此时，丘疹出现清亮液体的自发分泌及表面溃疡（图1）。受伤约3周后，对液体进行革兰氏染色；结果显示无细菌，但有中度白细胞反应。由于高度怀疑可能是结核感染，对液体进行了抗酸杆菌镜检，结果为抗酸杆菌阳性（++）（图2）。液体培养后生长出结核分枝杆菌。培养物被送往哥伦比亚波哥大国立卫生研究院的分枝杆菌实验室进行耐药性检测。结果显示对链霉素、异烟肼、利福平及乙胺丁醇敏感。在此期间，患者出现同侧腋窝疼痛性淋巴结肿大，直径约2.5厘米。患者咨询了感染病专家，专家启动了直接观察短程治疗（DOTS）方案[第一阶段（8周）：除周日外每日一次，链霉素1克肌肉注射，吡嗪酰胺1500毫克口服，异烟肼300毫克，利福平600毫克；第二阶段（18周）：每周两次，利福平600毫克和异烟肼500毫克]，同时每日服用吡哆醇以预防异烟肼的副作用。治疗3周后，手指病变消失。按照上述方法进行治疗，患者报告出现眩晕、恶心、上腹部疼痛及轻度肌痛等药物不良反应。进行了胸部X光检查，报告显示正常。受伤约6个月后腋窝淋巴结肿大消失。事件发生近3.5年后，患者未出现任何类型的症状。
