Gudivada Vijayalakshmi, Gochhait Debasis, Bhandary Chandni, Mishra Nimesh, Siddaraju Neelaiah
Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Diagn Cytopathol. 2019 Sep;47(9):935-938. doi: 10.1002/dc.24217. Epub 2019 Jun 7.
Nocardiosis is primarily a pulmonary infection commonly seen in immunocompromised individuals. However, lymphocutaneous nocardiosis is observed in immunocompetent individuals often after trauma. The clinical and cytomorphological features of lymphocutaneous nocardiosis closely mimic the most common infections in India such as tuberculosis and mycetoma (very common cutaneous infection with discharging sinus). As it is crucial to differentiate nocardiosis from tuberculosis, to avoid unnecessary antitubercular treatment, special stains like modified Ziehl-Neelsen stain and Gram stain can be employed to differentiate the morphology of Nocardia from tuberculosis. Fine-needle cytology from these cutaneous lesions helps in yielding adequate material for rapid and accurate diagnosis of immediate specific antibiotic treatment. We report a rare case that presented with clinical diagnosis of tuberculosis but turned out to be nocardiosis on cytomorphology with simple and most feasible fine-needle aspiration method of tissue diagnosis and scrape cytology.
诺卡菌病主要是一种肺部感染，常见于免疫功能低下的个体。然而，淋巴皮肤型诺卡菌病在免疫功能正常的个体中也会出现，通常发生在创伤后。淋巴皮肤型诺卡菌病的临床和细胞形态学特征与印度最常见的感染，如结核病和足菌肿（一种常见的有排脓窦道的皮肤感染）极为相似。由于区分诺卡菌病和结核病至关重要，以避免不必要的抗结核治疗，可采用改良齐-尼氏染色和革兰氏染色等特殊染色方法来区分诺卡菌与结核杆菌的形态。对这些皮肤病变进行细针穿刺细胞学检查有助于获取足够的材料，以便快速准确地诊断并立即进行特异性抗生素治疗。我们报告了一例罕见病例，该病例临床诊断为结核病，但通过简单且最可行的组织诊断细针抽吸方法和刮片细胞学检查，在细胞形态学上被诊断为诺卡菌病。
