Saunders Sarah, Jeffery Amanda, Hew Roger
Specialty Registrar Forensic Pathology, East Midlands Forensic Pathology Unit, Robert Kilpatrick Bldg., Leicester Royal Infirmary, LE2 7LX, UK.
Am J Forensic Med Pathol. 2012 Sep;33(3):276-9. doi: 10.1097/PAF.0b013e3181fe33d3.
We present a case of a 30-year-old woman with learning difficulties who was found dead at home by her mother. Her body was partially naked and covered in a number of unusual skin lesions with a targetoid appearance with red erythematous centers and well-delineated halos of pallor. These lesions were initially thought to be bruises by the police and by a forensic postmortem instigated. Postmortem examination also identified hepatosplenomegaly, severe lymphadenopathy, and focal patchy colonic ulceration. Histologic examination of the skin and bowel ulcers showed the lesions to be areas of infarction caused by Pseudomonas aeruginosa vasculitis. Pseudomonas was also cultured from the swabs of the abdomen, the spleen, and the blood cultures. Histologic findings of the lymph nodes showed complete effacement of the normal architecture by a population of pleomorphic small lymphoid cells. Immunohistochemistry confirmed the predominant cell type to be T-cells. The diagnosis of peripheral T-cell lymphoma was made. The cause of death was given as Pseudomonas septicemia secondary to immunocompromise resulting from the undiagnosed peripheral T-cell lymphoma. The pathogenesis of Pseudomonas and its association with malignancy is discussed along with a brief review of peripheral T-cell lymphomas. This case report demonstrates the characteristic macroscopic appearance of cutaneous Pseudomonas-associated lesions and how they can be misinterpreted as bruises.
我们报告一例30岁有学习困难的女性病例，她被母亲发现死于家中。她的尸体部分裸露，身上有许多外观异常的皮肤病变，呈靶样，中心为红色红斑，有界限清晰的苍白晕圈。警方和法医尸检最初认为这些病变是瘀伤。尸检还发现肝脾肿大、严重淋巴结病和局灶性斑片状结肠溃疡。皮肤和肠道溃疡的组织学检查显示，这些病变是由铜绿假单胞菌血管炎引起的梗死区域。从腹部拭子、脾脏和血培养物中也培养出了铜绿假单胞菌。淋巴结的组织学检查显示，正常结构被一群多形性小淋巴细胞完全破坏。免疫组织化学证实主要细胞类型为T细胞。诊断为外周T细胞淋巴瘤。死因是未诊断出的外周T细胞淋巴瘤导致免疫功能低下继发铜绿假单胞菌败血症。本文讨论了铜绿假单胞菌的发病机制及其与恶性肿瘤的关联，并对外周T细胞淋巴瘤进行了简要综述。本病例报告展示了皮肤铜绿假单胞菌相关病变的特征性宏观表现以及它们如何被误诊为瘀伤。
