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免疫功能正常患者播散性堪萨斯分枝杆菌感染伴皮肤损害

Disseminated Mycobacterium kansasii infection with cutaneous lesions in an immunocompetent patient.

作者信息

Zhang Miaomiao, Feng Mei, He Jian-Qing

机构信息

Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

出版信息

Int J Infect Dis. 2017 Sep;62:59-63. doi: 10.1016/j.ijid.2017.07.006. Epub 2017 Jul 14.

Abstract

A case of disseminated Mycobacterium kansasii infection involving the skin and soft tissue in a 57-year-old male farmer who presented with recurrent fever, respiratory syndromes, and skin lesions is reported. The positive findings of syndromes, laboratory examinations, and identification of M. kansasii in puncture fluid indicated the diagnosis of disseminated M. kansasii infection involving the skin and soft tissue, lungs, and mediastinal lymph nodes. After applying the standard HRE regimen (isoniazid 300mg/day, rifampicin 600mg/day, and ethambutol 750mg/day), the patient's temperature normalized and his symptoms improved gradually. No notable adverse drug reactions occurred and the skin lesions had healed after 4 months of follow-up. Disseminated M. kansasii infections occur mainly in immunocompromised patients. Moreover, disseminated infections with skin lesions is rare in immunocompetent patients. Following a review of the literature, only eight similar cases were identified as of disseminated M. kansasii infection with cutaneous lesions, and thecase presented here appears to be the second involving an immunocompetent individual. Special attention should be paid to a persistent and chronic rash following a chronic respiratory syndrome in order to exclude skin disease caused by non-tuberculous mycobacteria.

摘要

报告了一例57岁男性农民播散性堪萨斯分枝杆菌感染病例,该患者出现反复发热、呼吸道综合征和皮肤病变。综合征、实验室检查的阳性结果以及穿刺液中堪萨斯分枝杆菌的鉴定表明,该患者诊断为累及皮肤和软组织、肺部及纵隔淋巴结的播散性堪萨斯分枝杆菌感染。应用标准的HRE方案(异烟肼300mg/天、利福平600mg/天和乙胺丁醇750mg/天)后,患者体温恢复正常,症状逐渐改善。未发生明显的药物不良反应,随访4个月后皮肤病变已愈合。播散性堪萨斯分枝杆菌感染主要发生在免疫功能低下的患者中。此外,免疫功能正常的患者出现伴有皮肤病变的播散性感染较为罕见。经文献检索,截至目前仅发现8例类似的伴有皮肤病变的播散性堪萨斯分枝杆菌感染病例,此处报告的病例似乎是第二例累及免疫功能正常个体的病例。对于慢性呼吸道综合征后持续存在的慢性皮疹,应特别注意,以排除非结核分枝杆菌引起的皮肤病。

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