Department of Microbiology, Sumeru Hospital, Lalitpur, Nepal.
Tribhuvan University, Tri-Chandra Multiple Campus, Ghantaghar, Kathmandu, Nepal.
AIDS Res Ther. 2019 Jul 30;16(1):16. doi: 10.1186/s12981-019-0232-4.
Owing to similar clinical presentations, as of cutaneous disease of different etiologies, and extreme rarity in the global incidence; primary cutaneous actinomycosis often remains as diagnostic challenges.
Herein, we describe a case of primary cutaneous actinomycosis, erroneously treated as cutaneous tuberculosis, in a patient living with AIDS. On clinical examination, the characteristic lesion, resembling cutaneous tuberculosis, observed on the dorsum of a left leg. No other lesion elsewhere on the body was observed, however. Cytological examinations of the stabbed biopsy were negative for malignant cells; although hyper-keratosis and mild-acanthosis of epidermis, acute inflammatory infiltrates comprising plasma cell, macrophages and neutrophils were observed in the upper and mid dermis. The pus aspirated from lesion grew a molar tooth, adherent colonies in microaerophilic condition. Further, identifications and susceptibility pattern against recommended antibiotics were assessed as per the CLSI (Clinical and Laboratory Standard Institute) guidelines. Subsequently, the case was then, diagnosed as primary cutaneous actinomycosis. Radiographic imaging of abdomen and lungs were normal; no feature of disseminated actinomycosis seen. Penicillin G followed by Penicillin V, was prescribed for 12 months. The patient underwent progressive changes and no relapse noted on periodic follow-up.
The case underscores cutaneous actinomycosis requires a diagnosis consideration, especially in People Living with HIV/AIDS (PLHA), where myriad of opportunistic cutaneous infections are common.
由于不同病因的皮肤疾病临床表现相似，且在全球发病率极低；原发性皮肤放线菌病常难以诊断。
在此，我们描述了一例 AIDS 患者的原发性皮肤放线菌病，误诊为皮肤结核。临床检查时，左小腿背侧可见特征性病变，类似皮肤结核。但身体其他部位未见其他病变。穿刺活检的细胞学检查未发现恶性细胞；然而，在上皮和中真皮可见表皮角化过度和轻度棘皮症，急性炎症浸润包括浆细胞、巨噬细胞和中性粒细胞。从病变部位抽吸的脓液中培养出了一株磨牙状、附着于微需氧条件下的菌落。此外，根据 CLSI（临床和实验室标准协会）指南评估了对推荐抗生素的鉴定和药敏模式。随后，该病例被诊断为原发性皮肤放线菌病。腹部和肺部的影像学检查正常；未发现播散性放线菌病的特征。给予青霉素 G 随后是青霉素 V，治疗 12 个月。患者病情逐渐好转，定期随访未见复发。
该病例强调了在 HIV/AIDS 患者（PLHA）中，需要考虑皮肤放线菌病的诊断，因为那里常见多种机会性皮肤感染。
