Ariza J, Servitje O, Pallarés R, Fernández Viladrich P, Rufí G, Peyrí J, Gudiol F
Department of Medicine, Hospital de Bellvitge, Universidad de Barcelona, Spain.
Arch Dermatol. 1989 Mar;125(3):380-3.
Among 436 cases of brucellosis included in a 12-year prospective protocol, we identified 27 patients (6%) with cutaneous lesions (13 men and 14 women; mean age, 35.1 +/- 16.5 years). Twenty-one patients had positive blood cultures for Brucella melitensis. A disseminated violet-erythematous, papulonodular eruption (20 cases) and erythema nodosum-like lesions (three cases) were the most frequent eruptions observed, appearing during the initial episode of the disease or in relapse. Histologic findings were a dermal inflammatory infiltrate of lymphocytes and histiocytes in a perivascular and periadnexal arrangement, with a focally granulomatous appearance, and occasional extension to subcutaneous fat. Skin cultures were positive for B melitensis in two of four cases. Our results suggest that there are characteristic clinical and histologic cutaneous findings in patients with brucellosis and that hematogenous spread of the microorganism can be the most important pathogenic mechanism of these lesions.
在一项为期12年的前瞻性研究方案纳入的436例布鲁氏菌病患者中，我们识别出27例（6%）有皮肤损害的患者（13例男性和14例女性；平均年龄35.1±16.5岁）。21例患者血培养布鲁氏菌羊种阳性。最常见的皮疹为播散性紫红斑丘疹（20例）和结节性红斑样损害（3例），出现在疾病的初始发作期或复发期。组织学表现为真皮层淋巴细胞和组织细胞呈血管周围及附件周围排列的炎性浸润，有局灶性肉芽肿外观，偶尔累及皮下脂肪。4例中有2例皮肤培养布鲁氏菌羊种阳性。我们的结果提示，布鲁氏菌病患者有特征性的临床和组织学皮肤表现，且微生物的血行播散可能是这些损害最重要的致病机制。
