Chen Zhe-Qi, Huang Jie-Feng, Ma Li-Li, Zhang Chun-Li, Lei Shu
1 Department of ICU, The First Affiliated Hospital of ZheJiang Chinese Medical University, Zhejiang Provincial Hospital of TCM, Hangzhou, China.
2 Department of Orthopedics, The First Affiliated Hospital of ZheJiang Chinese Medical University, Zhejiang Provincial Hospital of TCM, Hangzhou, China.
J Int Med Res. 2018 Aug;46(8):3468-3473. doi: 10.1177/0300060518780124. Epub 2018 Jun 25.
Pyoderma gangrenosum (PG) is a rare ulcerative inflammatory dermatosis easily confused with wound infection following surgery. There have been seven case reports of PG occurring after total knee arthroplasty (TKA), all of which used routine tissue culture for differential diagnosis. Notably, all previous cases involved delayed diagnosis. We report a case of PG after TKA where we used shotgun metagenomics for differential diagnosis. Metagenomic analysis is a new method that can be used for pathogen detection; it is fast and sensitive, compared with traditional culture. Early application of metagenomic analysis in cases of suspicious wound infection after surgery can detect the pathogen of the infection for target therapy; it can also exclude infection for differential diagnosis of non-infectious diseases, such as autoimmune disorders. This case is presented to support the use of metagenomic analysis by surgeons and physicians for early and rapid differential diagnosis in patients who exhibit postoperative wound infections.
坏疽性脓皮病（PG）是一种罕见的溃疡性炎症性皮肤病，很容易与术后伤口感染相混淆。全膝关节置换术（TKA）后发生PG的病例报告已有7例，所有这些病例均采用常规组织培养进行鉴别诊断。值得注意的是，既往所有病例均存在诊断延迟的情况。我们报告1例TKA术后发生PG的病例，我们采用鸟枪法宏基因组学进行鉴别诊断。宏基因组分析是一种可用于病原体检测的新方法；与传统培养方法相比，它快速且灵敏。在术后可疑伤口感染病例中早期应用宏基因组分析，可检测出感染病原体以进行靶向治疗；还可排除感染，用于自身免疫性疾病等非感染性疾病的鉴别诊断。本文报告此病例是为了支持外科医生和内科医生使用宏基因组分析，对术后伤口感染的患者进行早期快速鉴别诊断。
