Weinberg Monica, Bag-Ozbek Ayse, Chen Davina, Yao Qingping
Division of Rheumatology, Allergy and Immunology, Department of Medicine, Stony Brook University Renaissance School of Medicine, Stony Brook University Hospital, HSC, T-16, 047, Stony Brook, NY, 11794-8161, USA.
Veterans Administration Medical Centers, Northport, NY, USA.
Rheumatol Int. 2021 Sep;41(9):1691-1697. doi: 10.1007/s00296-020-04697-z. Epub 2020 Sep 5.
Mycobacterial infection can be seriously debilitating and challenging to diagnose. The infection can mimic vasculitis associated with positive anti-neutrophilic cytoplasmic autoantibodies (ANCA). This clinical scenario is exemplified with a well-studied case of a 63-year-old Caucasian man with uncontrolled diabetes and ulcerative colitis on immunosuppressive agents. The patient was hospitalized for 3 months with worsening painful hand ulcerations. Primary vasculitis was first suspected, but the patient was later diagnosed with vasculitis secondary to Mycobacterium chelonae infection. Report includes discussion on sequence of testing which led to the diagnosis. After proper diagnosis and change to proper antibiotics, the patient's vasculitis improved over time. It is our hope that this report further raises awareness of mycobacterial infection as a mimicker of vasculitis. We also provide a review of relevant literature on non-tuberculosis mycobacterial (NTM) infection including a review of 22 articles and 12 cases found in the literature. The salient features of the literature review include that 10 of the 12 cases were patients who had risk factors of immunosuppression due to medications, and all patients were infected by mycobacterium causing skin vasculitis. After given the proper directed antibiotic treatment, 11 of the 12 patients had a reported improved outcome.
分枝杆菌感染可能会严重削弱身体机能且诊断颇具挑战性。这种感染可能会模仿与抗中性粒细胞胞浆自身抗体（ANCA）阳性相关的血管炎。一名63岁患有未控制的糖尿病和溃疡性结肠炎且正在服用免疫抑制剂的白人男性的详尽研究病例便是这种临床情况的例证。该患者因手部疼痛性溃疡恶化住院3个月。最初怀疑是原发性血管炎，但该患者后来被诊断为龟分枝杆菌感染继发的血管炎。报告包括对导致诊断的检测顺序的讨论。经过正确诊断并更换为合适的抗生素后，患者的血管炎随着时间推移有所改善。我们希望这份报告能进一步提高人们对分枝杆菌感染作为血管炎模仿者的认识。我们还对有关非结核分枝杆菌（NTM）感染的相关文献进行了综述，包括对文献中发现的22篇文章和12个病例的综述。文献综述的显著特点包括，12例病例中有10例是因药物导致免疫抑制风险因素的患者，且所有患者均感染了导致皮肤血管炎的分枝杆菌。在给予适当的针对性抗生素治疗后，12例患者中有11例报告病情有所改善。
