Vetter Anna, Geerdes-Fenge Hilte, Saß Marco, Hühns Maja, Becker Anne-Sophie
Institut für Pathologie, Universitätsmedizin Rostock, Strempelstr. 14, 18057, Rostock, Deutschland.
Abteilung für Tropenmedizin und Infektionskrankheiten, Zentrum für Innere Medizin, Universitätsmedizin Rostock, Rostock, Deutschland.
Pathologie (Heidelb). 2025 Jun 2. doi: 10.1007/s00292-025-01442-w.
A 60-year-old immunocompetent patient presented with painless subcutaneous nodules on the right hand and forearm that progressed over several weeks. Nodules were clinically classified as a soft tissue tumor of primarily mesenchymal origin. After extirpation of two nodules for diagnostic clarification, histology showed a chronic granulomatous inflammation of the dermis and subcutis with central eosinophilic necrosis including cell debris. Light microscopy showed no acid-fast rods, but molecular diagnostics revealed DNA of Mycobacterium haemophilum as a nontuberculoid mycobacterium (NTM). The infection was identified as the cause of the nodules based on the classic histomorphology of necrotizing-granulomatous inflammation in addition to PCR-based pathogen diagnostics. This case illustrates the clinical presence of mycobacterial infections, especially in extrapulmonary and extranodal localizations. In addition to cutaneous foci of infection, NTM infections may cause multisystem disease involving the joint system, depending on the host's immunocompetence, which can be treated with antibiotics.
一名60岁免疫功能正常的患者右手和前臂出现无痛性皮下结节，持续数周逐渐进展。结节在临床上被分类为主要起源于间充质的软组织肿瘤。为明确诊断切除两个结节后，组织学显示真皮和皮下组织有慢性肉芽肿性炎症，伴有中央嗜酸性坏死，包括细胞碎片。光学显微镜未发现抗酸杆菌，但分子诊断显示嗜血性分枝杆菌的DNA，这是一种非结核分枝杆菌（NTM）。除基于PCR的病原体诊断外，根据坏死性肉芽肿性炎症的经典组织形态学，该感染被确定为结节的病因。该病例说明了分枝杆菌感染的临床表现，尤其是在肺外和结外部位。除皮肤感染灶外，NTM感染可能根据宿主的免疫功能导致涉及关节系统的多系统疾病，可用抗生素治疗。
