Arshad Muhammad, Kumar Aakash, Shafique Ur Rehman Muaz, Tito Rodriguez Piere R, Varrassi Giustino
Rheumatology, National Hospital and Medical Centre, Lahore, PAK.
Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK.
Cureus. 2024 Jan 11;16(1):e52139. doi: 10.7759/cureus.52139. eCollection 2024 Jan.
Atypical mycobacterial infections can have diverse clinical presentations, frequently resulting in diagnostic challenges. This study examines an uncommon atypical mycobacterial disease in an older patient, initially misidentified as psoriasis, emphasizing the difficulties in diagnosing and managing the condition. A 70-year-old male patient arrived at the dermatology department at National Hospital and Medical Centre, Lahore, with a persistent, dry, red rash mainly affecting his arms and legs. The patient had a medical background of diabetes mellitus and hypertension. Initial clinical diagnosis suggested psoriasis based on the appearance and patient's age. The patient was started on conventional psoriatic therapies. However, there was only a slight improvement, which led to the need for additional inquiry. Skin biopsies were conducted, uncovering the presence of granulomatous inflammation. Following cultures and polymerase chain reaction (PCR) tests, the presence of atypical mycobacteria was established. Subsequent laboratory tests eliminated the possibility of tuberculosis (TB) and other prevalent diseases. The conclusive diagnosis was an unusual mycobacterial infection, which posed a challenge due to its clinical similarity to psoriasis. The patient was treated with antibiotics appropriate to the mycobacterial species discovered. The duration of the treatment spanned six months, resulting in a notable amelioration of the skin lesions. The patient is being closely observed for any potential reoccurrence. This case highlights the significance of including atypical mycobacterial infection as a possible diagnosis for persistent dermatological problems, particularly in persons with impaired immune systems. It emphasizes the need for biopsy and culture in unusual situations of suspected psoriasis. This instance also demonstrates the intricacies associated with managing older patients with multiple concurrent medical issues. Unusual mycobacterial infections can imitate conventional skin disorders such as psoriasis, presenting considerable difficulties in diagnosis. Having a strong suspicion and doing relevant laboratory tests are essential for achieving an accurate diagnosis and efficient treatment.
非典型分枝杆菌感染可呈现多种临床表现，常常导致诊断难题。本研究考察了一名老年患者所患的一种罕见非典型分枝杆菌病，该病最初被误诊为银屑病，强调了诊断和处理该病症的困难。一名70岁男性患者前往拉合尔国立医院和医疗中心皮肤科就诊，其双臂和双腿出现持续的、干燥的红色皮疹。该患者有糖尿病和高血压病史。基于皮疹外观和患者年龄，初步临床诊断为银屑病。患者开始接受常规银屑病治疗。然而，仅有轻微改善，这促使需要进一步询问。进行了皮肤活检，发现存在肉芽肿性炎症。经过培养和聚合酶链反应（PCR）检测，确定存在非典型分枝杆菌。随后的实验室检测排除了结核病（TB）和其他常见疾病的可能性。最终诊断为一种罕见的分枝杆菌感染，因其在临床上与银屑病相似而构成挑战。患者接受了针对所发现分枝杆菌种类的抗生素治疗。治疗持续了六个月，皮肤病变有显著改善。患者正在接受密切观察以防任何潜在复发。该病例凸显了将非典型分枝杆菌感染作为持续性皮肤问题的可能诊断的重要性，尤其是在免疫系统受损的人群中。它强调了在疑似银屑病的不寻常情况下进行活检和培养的必要性。这个病例还展示了管理患有多种并发疾病的老年患者的复杂性。非典型分枝杆菌感染可模仿银屑病等传统皮肤疾病，在诊断上存在相当大的困难。保持高度怀疑并进行相关实验室检测对于实现准确诊断和有效治疗至关重要。
