Kato Hirofumi, Sasaki Shugo, Sekiya Noritaka
Department of Clinical Laboratory, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
Medicine (Baltimore). 2016 Jun;95(26):e3988. doi: 10.1097/MD.0000000000003988.
Primary extraintestinal complications caused by Yersinia enterocolitica are extremely rare, especially in the form of skin and soft-tissue manifestations, and little is known about their clinical characteristics and treatments. We presented our case and reviewed past cases of primary skin and soft-tissue infections caused by Y enterocolitica. We report a case of primary cellulitis and cutaneous abscess caused by Y enterocolitica in an immunocompetent 70-year-old woman with keratodermia tylodes palmaris progressiva. She presented to an outpatient clinic with redness, swelling, and pain of the left ring finger and left upper arm without fever or gastrointestinal symptoms 3 days before admission. One day later, ulceration of the skin with exposed bone of the proximal interphalangeal joint of the left ring finger developed, and cefditoren pivoxil was described. However, she was admitted to our hospital due to deterioration of symptoms involving the left finger and upper arm. Cefazolin was initiated on admission, then changed to sulbactam/ampicillin and vancomycin with debridement of the left ring finger and drainage of the left upper arm abscess. Wound culture grew Y enterocolitica serotype O:8 and methicillin-sensitive Staphylococcus aureus. Blood cultures were negative and osteomyelitis was ruled out. Vancomycin was switched to ciprofloxacin, then skin and soft-tissue manifestations showed clear improvement within a few days. The patient received 14 days of ciprofloxacin and oral amoxicillin/clavulanate and has since shown no recurrence. We reviewed 12 cases of primary skin and soft-tissue infections caused by Y enterocolitica from the literature. In several past cases, portal entry involved failure of the skin barrier on distal body parts. Thereafter, infection might have spread to the regional lymph nodes from the ruptured skin. Y enterocolitica is typically resistant to aminopenicillins and narrow-spectrum cephalosporins. In most cases, these inefficient antibiotic agents were initially prescribed, but patient conditions rapidly improved after implementing appropriate therapy and drainage. In addition, primary skin and soft-tissue infections occurred even in patients lacking risk factors. Physicians should consider the rare differential diagnosis of Y enterocolitica infection when seeing patients with deteriorating skin lesions under standard treatment, even if the patient is immunocompetent.
小肠结肠炎耶尔森菌引起的原发性肠外并发症极为罕见，尤其是皮肤和软组织表现形式，对其临床特征和治疗方法知之甚少。我们报告了我们的病例，并回顾了过去由小肠结肠炎耶尔森菌引起的原发性皮肤和软组织感染病例。我们报告了一例由小肠结肠炎耶尔森菌引起的原发性蜂窝织炎和皮肤脓肿，患者是一名70岁免疫功能正常的女性，患有进行性掌跖角化病。入院前3天，她前往门诊就诊，左环指和左上臂出现红肿和疼痛，无发热或胃肠道症状。一天后，左环指近端指间关节皮肤溃疡并露出骨头，开始使用头孢妥仑匹酯治疗。然而，由于左手指和上臂症状恶化，她被收治入院。入院时开始使用头孢唑林，随后改为舒巴坦/氨苄西林和万古霉素，并对左环指进行清创术，对左上臂脓肿进行引流。伤口培养结果显示为小肠结肠炎耶尔森菌血清型O:8和甲氧西林敏感金黄色葡萄球菌。血培养结果为阴性，排除骨髓炎。万古霉素改为环丙沙星，几天后皮肤和软组织表现明显改善。患者接受了14天的环丙沙星和口服阿莫西林/克拉维酸治疗，此后未再复发。我们从文献中回顾了12例由小肠结肠炎耶尔森菌引起的原发性皮肤和软组织感染病例。在过去的一些病例中，感染途径涉及身体远端部位皮肤屏障功能失效。此后，感染可能从破裂的皮肤扩散至区域淋巴结。小肠结肠炎耶尔森菌通常对氨基青霉素和窄谱头孢菌素耐药。在大多数情况下，最初会开具这些无效的抗生素药物，但在实施适当的治疗和引流后，患者病情迅速改善。此外，即使在缺乏危险因素的患者中也会发生原发性皮肤和软组织感染。医生在诊治标准治疗下皮肤病变恶化的患者时，即使患者免疫功能正常，也应考虑小肠结肠炎耶尔森菌感染这种罕见的鉴别诊断。
