Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon.
J Eur Acad Dermatol Venereol. 2011 Jan;25(1):33-42. doi: 10.1111/j.1468-3083.2010.03684.x.
Only a few studies characterized cutaneous non-tuberculous Mycobacterium (NTM) infections in this region of the world. Objective The aim of this study was to describe the epidemiological, clinical and histological findings of cutaneous NTM infections in Lebanon.
PATIENTS/METHODS: Retrospective study of 17 patients (19 histological specimens) diagnosed with cutaneous NTM infections and confirmed by culture-based partial sequencing of the 16S rRNA gene at the American University of Beirut Medical Center between 2005 and 2008.
Of 17 cases, 14 were caused by Mycobacterium marinum. All patients were immunocompetent except for one. Clinically, the most common presentation was multiple sporotrichoid lesions over an extremity (8/17). Many patients had peculiar presentations including bruise-like patches, herpetiform lesions, annular ulcerated plaques, symmetrical nodules over the buttocks and locally disseminated lesions with surrounding pale halo. Almost all patients cleared their infection on either minocycline or clarithromycin monotherapies. Histologically, a dermal small vessel proliferation with mixed inflammation (granulation tissue-like changes) was identified in 58% of specimens. The most common type of granulomatous inflammation was the suppurative (47%) followed by the tuberculoid (30%), sarcoidal (11%), and palisading (5%) types. Lichenoid granulomatous dermatitis was noted in 42% of cases. Special staining highlighted mycobacteria in only two specimens.
The incidence of cutaneous NTM infections is high in our area. Many patients had peculiar clinical presentations. Our study is the second to report the common presence of granulation tissue-like changes as a good histological indicator of cutaneous NTM infections. Minocycline and clarithromycin remain the drugs of choice in our area.
仅有少数研究对该地区的皮肤非结核分枝杆菌（NTM）感染进行了描述。目的：本研究旨在描述黎巴嫩皮肤 NTM 感染的流行病学、临床和组织学特征。
患者/方法：回顾性研究了 2005 年至 2008 年期间在贝鲁特美国大学医学中心通过基于培养的 16S rRNA 基因部分测序确诊的 17 例皮肤 NTM 感染患者（19 个组织学标本）。
17 例患者中，14 例由海分枝杆菌引起。除 1 例患者外，所有患者均为免疫功能正常者。临床上，最常见的表现是四肢多发性孢子丝菌样病变（17/17）。许多患者表现奇特，包括瘀斑样斑块、疱疹样病变、环形溃疡性斑块、臀部对称结节和周围苍白晕的局灶性播散性病变。几乎所有患者均能在米诺环素或克拉霉素单药治疗下清除感染。组织学上，58%的标本发现真皮小血管增生伴混合炎症（类肉芽组织样改变）。最常见的肉芽肿性炎症类型为化脓性（47%），其次为结核样（30%）、类肉瘤样（11%）和栅栏状（5%）。42%的病例可见苔藓样肉芽肿性皮炎。特殊染色仅在 2 个标本中突出显示分枝杆菌。
我们地区皮肤 NTM 感染的发病率较高。许多患者的临床表现较为奇特。本研究是第二份报告称类肉芽组织样改变为皮肤 NTM 感染的良好组织学指标。米诺环素和克拉霉素仍然是我们地区的首选药物。
