Bryant Penelope Ann, Shingadia Delane V
Great Ormond Street Hospital, Infectious Diseases, Great Ormond Street, London WC1N 3JH, UK.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.11.2008.1220. Epub 2009 Aug 10.
Over the course of 6 months, an 8-year-old boy presented with cutaneous lumps: a postauricular lump, a fluctuant scalp lump, a lump adjacent to his shin, and a firm chest wall lump. Although he was born in the UK, his family were from Kenya and had visited there after the symptoms started. After multiple courses of antibiotics and antifungals with no improvement, he underwent ultrasound scanning that showed erosion of bone under the lumps and computed tomographic (CT) scanning which showed tibial osteomyelitis. A biopsy of the chest wall lump showed granulomatous inflammation, and pus was extracted from the shin lump that was negative on Ziehl-Neilsen and Gram staining. A tuberculin skin test was equivocal, Quantiferon test positive and 12 days later Mycobacterium tuberculosis was cultured from the pus. The patient was started on quadruple antituberculous therapy and his skin lumps have improved. The long term outcome of the osteomyelitis remains to be seen.
在6个月的时间里，一名8岁男孩出现了皮肤肿块：一个耳后肿块、一个波动感的头皮肿块、一个胫骨旁肿块以及一个坚硬的胸壁肿块。尽管他出生在英国，但他的家人来自肯尼亚，在症状出现后曾去过那里。在接受了多疗程的抗生素和抗真菌药物治疗后仍无改善，他接受了超声扫描，结果显示肿块下方的骨质有侵蚀，还进行了计算机断层扫描（CT），结果显示胫骨骨髓炎。胸壁肿块的活检显示为肉芽肿性炎症，从胫骨肿块中抽出的脓液经萋-尼氏染色和革兰氏染色均为阴性。结核菌素皮肤试验结果不明确，全血γ-干扰素释放试验结果为阳性，12天后从脓液中培养出结核分枝杆菌。患者开始接受四联抗结核治疗，其皮肤肿块已有所改善。骨髓炎的长期预后仍有待观察。
