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结核分枝杆菌感染所致的手部脓疱疹引发前臂广泛感染:一例报告

Left extensive infection in the forearm caused by whitlow infected by mycobacterium tuberculosis: A case report.

作者信息

Wang Tao, Zhao Gang, Rui Yong-Jun, Lu Zheng-Feng, Mi Jing-Yi

机构信息

Department of Hand Surgery, Wuxi No. 9 People's Hospital Affiliated to Soochow University, Wuxi, China.

出版信息

Medicine (Baltimore). 2017 Dec;96(48):e8992. doi: 10.1097/MD.0000000000008992.

Abstract

INTRODUCTION

Whitlow is a common disease in clinic, characterized by pain and swelling of finger. However, few articles had reported on extensive infection in the forearm caused by whitlow infected by mycobacterium tuberculosis (MTB).

PATIENT CONCERNS

A 70-year-old Chinese female complained of fester in back of left hand for 5 days. She had a history of recurrent whitlow for 14 months and pulmonary tuberculosis (TB). She received treatment in another hospital due to whitlow on July 2016. Then she was treated with incision and drainage. However, whitlow presented again several times before coming to our hospital. She came to our hospital on September 7, 2017 and x-ray of forearm showed that radius, ulna, and carpal were eroded.

DIAGNOSES

She was diagnosed with left extensive infection in the forearm caused by whitlow infection by MTB.

INTERVENTIONS

Considering her serious and extensive condition, we performed left forearm amputation on September 12, 2017. We collected some soft tissue cut down during surgery and conducted pathological examination. Finally, pathological result showed MTB infection. Then that patient was treated with antituberculosis therapy.

OUTCOMES

Up to now, illness condition has not progressed. A recent x-ray of forearm showed no osteolysis in humerus.

CONCLUSIONS

Extensive infection in the forearm after recurrent whitlow infection by MTB is rare. So when we face recurrent whitlow, a rapid diagnosis and treatment are required to prevent complications. This case reminds us that recurrent whitlow is dangerous. Attention must be paid to recurrent whitlow. If necessary, amputation should be considered.

摘要

引言

脓性指头炎是临床上的常见疾病,表现为手指疼痛和肿胀。然而,关于结核分枝杆菌(MTB)感染脓性指头炎导致前臂广泛感染的报道较少。

患者情况

一名70岁中国女性,主诉左手背溃烂5天。她有14个月反复脓性指头炎病史及肺结核病史。2016年7月因脓性指头炎在另一家医院接受治疗,当时行切开引流术。但在来我院之前脓性指头炎又多次复发。2017年9月7日来我院,前臂X线显示桡骨、尺骨及腕骨有骨质侵蚀。

诊断

诊断为MTB感染脓性指头炎导致左前臂广泛感染。

干预措施

考虑到她病情严重且感染范围广,于2017年9月12日行左前臂截肢术。术中取部分切除的软组织进行病理检查,最终病理结果显示为MTB感染,随后该患者接受抗结核治疗。

结果

截至目前,病情未进展。近期前臂X线显示肱骨无骨质溶解。

结论

MTB反复感染脓性指头炎后导致前臂广泛感染较为罕见。因此,面对反复脓性指头炎时,需要快速诊断和治疗以预防并发症。该病例提醒我们反复脓性指头炎很危险,必须重视。必要时应考虑截肢。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3487/5728815/e24150f12113/medi-96-e8992-g001.jpg

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