Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
J Infect. 2013 Oct;67(4):265-72. doi: 10.1016/j.jinf.2013.06.004. Epub 2013 Jun 14.
To determine the diagnostic yield of skin biopsy in patients with leukemia, new skin lesions, and suspected infection.
We reviewed the medical records of all patients with leukemia who underwent skin biopsy for new lesions and clinical suspicion of infection over 4 years. Biopsy was considered to have changed the diagnosis, if the results differed from the prior leading clinical impression.
Seventy-six (39%) of 195 patients had infections identified via skin biopsy. Among the remaining patients, the most common diagnoses were leukemia cutis, drug reactions and Sweet's syndrome. Ulcerated or necrotic lesions and bacteremia or fungemia were the only independent predictors of infection. 55% of patients with severe neutropenia had biopsy-proven infectious causes of their skin lesions. One third of all afebrile patients had skin manifestations owing to infection. Skin biopsy results differed from the initial clinical impression in 34% of all patients. In 45% of infected patients, pathogens were identified by skin biopsy alone.
Noninfectious causes accounted for a large proportion of new skin lesions in leukemia patients with suspected infections. Absence of neutropenia or fever did not rule out infection. Ulcerated or necrotic lesions and bacteremia or fungemia were independent predictors of infection. In the evaluation of patients with leukemia and new skin lesions, skin biopsy remains an important procedure to rule out infection, and is particularly useful for pathogen identification.
确定有新发皮肤病变和疑似感染的白血病患者进行皮肤活检的诊断收益。
我们回顾了 4 年来所有因新发皮肤病变和疑似感染而行皮肤活检的白血病患者的病历。如果活检结果与之前的主要临床印象不同，则认为活检改变了诊断。
195 例患者中有 76 例（39%）通过皮肤活检发现感染。在其余患者中，最常见的诊断为白血病皮肤表现、药物反应和 Sweet 综合征。溃疡或坏死性病变以及菌血症或真菌血症是感染的唯一独立预测因素。55%的严重中性粒细胞减少症患者的皮肤病变有活检证实的感染原因。三分之一的无发热患者的皮肤表现是由感染引起的。皮肤活检结果与所有患者的初始临床印象在 34%的情况下存在差异。在 45%的感染患者中，仅通过皮肤活检即可确定病原体。
在疑似感染的白血病患者中，新发皮肤病变的非感染性原因占很大比例。无中性粒细胞减少症或发热并不能排除感染。溃疡或坏死性病变以及菌血症或真菌血症是感染的独立预测因素。在评估白血病和新发皮肤病变的患者时，皮肤活检仍然是排除感染的重要程序，对于确定病原体特别有用。
