Moyses-Neto Miguel, Drumond Daniel, Morgantetti Giuliano, Garcia Tania Maria Pisi, Bolella Valdes Roberto, Romao Elen Almeida
Divisão de Nefrologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
Departamento de Patologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
Rev Soc Bras Med Trop. 2017 Jul-Aug;50(4):565-567. doi: 10.1590/0037-8682-0090-2016.
Seven months after undergoing kidney transplantation, a 56-year-old woman presented with papules and ulcers in her right forearm. The patient received antibiotics for 8 months with limited improvement. Eleven months after symptom onset, she presented with acute arthritis in her left knee. Asynovial fluid culture yielded Mycobacterium tuberculosis, and a forearm ulcer biopsy showed granulomatous inflammation. After surgical fistulectomy and 12 months of tuberculosis treatment, she was cured. Chronic cutaneous ulcers and articular manifestations in TB are rare, but they should always be considered in the differential diagnosis for immunosuppressed patients. Surgical intervention and prolonged treatment might be necessary.
一名56岁女性在接受肾移植7个月后，右前臂出现丘疹和溃疡。患者接受了8个月的抗生素治疗，改善有限。症状出现11个月后，她左膝出现急性关节炎。滑液培养检出结核分枝杆菌，前臂溃疡活检显示肉芽肿性炎症。经过手术切除瘘管并进行12个月的抗结核治疗后，她治愈了。结核中的慢性皮肤溃疡和关节表现很少见，但在免疫抑制患者的鉴别诊断中应始终予以考虑。可能需要手术干预和长期治疗。
