Suzuki Y, Toyama K, Utsugi K, Yazawa K, Mikami Y, Fujita M, Shinkai H
Department of Dermatology, Chiba University, School of Medicine, Japan.
J Dermatol. 1995 May;22(5):344-7. doi: 10.1111/j.1346-8138.1995.tb03400.x.
We report a case of lymphocutaneous syndrome caused by Nocardia otitidiscaviarum (formerly known as N. caviae) in a 78-year-old woman who underwent long-term therapy with prednisolone for bronchial asthma. Histological examination showed granulomatous reaction with multiple polymorphonuclear leukocytes and revealed a Gram positive filament in the dermis. Gram-positive, slightly acid-fast branched filaments were also found in the smear of the purulent material. The cell wall constituents of the isolate were meso-diaminopimelic acid, arabinose, and galactose; the mycolic acid pattern of the isolate was Nocardia type. The organism decomposed xanthine and hypoxanthine, but not tyrosine or casein, which distinguished it from N. asteroides and N. brasiliensis. The skin lesions responded to minocycline and later to a combination of doxycycline and ofloxacin. This primary lymphocutaneous nocardiosis due to N. otitidiseaviarum is the first in Japan.
我们报告了一例由耳氏诺卡菌（原称豚鼠诺卡菌）引起的皮肤淋巴综合征，患者为一名78岁女性，因支气管哮喘接受泼尼松龙长期治疗。组织学检查显示有肉芽肿反应，伴有多个多形核白细胞，并在真皮中发现革兰氏阳性细丝。在脓性物质涂片中也发现了革兰氏阳性、微抗酸的分支细丝。分离株的细胞壁成分是内消旋二氨基庚二酸、阿拉伯糖和半乳糖；分离株的分枝菌酸模式为诺卡菌型。该菌株能分解黄嘌呤和次黄嘌呤，但不能分解酪氨酸或酪蛋白，这使其与星形诺卡菌和巴西诺卡菌相区别。皮肤病变对米诺环素有效，后来对强力霉素和氧氟沙星联合用药也有效。这例由耳氏诺卡菌引起的原发性皮肤淋巴型诺卡菌病在日本尚属首例。
