Giordano Cerrene Nicole, Kalb Robert E, Brass Corstiaan, Lin Lin, Helm Thomas N
University at Buffalo School of Medicine and Biomedical Sciences, USA.
Dermatol Online J. 2010 Sep 15;16(9):1.
A 54-year-old man with asthma, mitral valve prolapse, and a back injury developed erythematous nodules that progressed along the lymphatic drainage of his right arm. Skin biopsy revealed granulomatous inflammation with microabscess formation. Culture confirmed Mycobacterium marinum infection. The patient was treated with clarithromycin, ethambutol, rifampin, and topical silver sulfadiazine. Oral doxycycline hyclate was later added because of slow healing. Mycobacterium marinum is one of a group of infectious agents that can cause nodular lymphangitis. Sporotrichoid lesions most commonly develop after cutaneous inoculation with Sporothrix schenckii, Leishmania species, Nocardia species, and Mycobacterium marinum. A thorough clinical history and physical examination can narrow the differential diagnosis by eliciting information about the etiologic setting, incubation time, clinical appearance of the lesions, and presence or absence of systemic involvement for each of the causative organisms. Skin biopsy and microbiological tissue cultures are essential for diagnostic confirmation. The differential diagnosis and a suggested diagnostic paradigm will be reviewed.
一名患有哮喘、二尖瓣脱垂和背部损伤的54岁男性出现了沿右臂淋巴引流发展的红斑结节。皮肤活检显示肉芽肿性炎症并伴有微脓肿形成。培养证实为海分枝杆菌感染。患者接受了克拉霉素、乙胺丁醇、利福平以及局部应用磺胺嘧啶银治疗。由于愈合缓慢，后来加用了口服盐酸多西环素。海分枝杆菌是可引起结节性淋巴管炎的一组感染病原体之一。孢子丝菌样病变最常见于皮肤接种申克孢子丝菌、利什曼原虫属、诺卡菌属和海分枝杆菌之后。通过获取每种致病生物体的病因背景、潜伏期、病变的临床表现以及是否存在全身受累等信息，全面的临床病史和体格检查可缩小鉴别诊断范围。皮肤活检和微生物组织培养对于确诊至关重要。将对鉴别诊断及建议的诊断模式进行综述。
