Peltier E, Wolkenstein P, Deniau M, Zafrani E S, Wechsler J
Service d'Anatomie et de Cytologie Pathologiques, Hôpital Antoine Béclère, Clamart, France.
J Clin Pathol. 1996 Jun;49(6):517-9. doi: 10.1136/jcp.49.6.517.
A case of late stage cutaneous leishmaniasis with focal caseous necrosis is reported. The patient, a 30 year old Tunisian man, presented with idiopathic bone marrow aplasia. Microscopically, minimal changes were observed in the epidermis: slight hyperkeratosis and moderate acanthosis. Lesions predominated in the dermis. Epithelioid granulomas were found in the lower dermis. Some of these lesions were clearly surrounded by a ring of lymphocytes and were rarely confluent. A peculiar histological feature was the presence of focal acidophilic and slightly granular necrosis at the centre of some the tuberculoid lesions. Focal fibrinoid necrosis was found in the upper dermis, outside granulomas. A mild to moderate infiltrate of histiocytes, lymphocytes and plasma cells, with scanty neutrophils, was observed mainly in the upper dermis. No intracellular or extracellular Leishman-Donovan bodies were observed. Acid fast mycobacteria, however, were not detected. Leishmaniasis was diagnosed on culture of skin biopsy specimens. The presence of caseous necrosis could lead to diagnostic confusion and result in an erroneous diagnosis of, for example, tuberculosis, syphilis, acne agminata, and sarcoidosis with fibrinoid necrosis. This is especially the case when parasites are scanty or absent.
报告了一例伴有局灶性干酪样坏死的晚期皮肤利什曼病病例。患者为一名30岁的突尼斯男子，患有特发性骨髓再生障碍。显微镜下，表皮观察到轻微变化：轻度角化过度和中度棘层肥厚。病变主要位于真皮。在真皮下部发现上皮样肉芽肿。其中一些病变明显被淋巴细胞环包围，很少融合。一个特殊的组织学特征是在一些结核样病变的中心存在局灶性嗜酸性和轻度颗粒状坏死。在肉芽肿外的真皮上部发现局灶性纤维蛋白样坏死。主要在真皮上部观察到轻度至中度的组织细胞、淋巴细胞和浆细胞浸润，中性粒细胞较少。未观察到细胞内或细胞外利杜体。然而，未检测到抗酸分枝杆菌。通过皮肤活检标本培养诊断为利什曼病。干酪样坏死的存在可能导致诊断混淆，并导致错误诊断，例如结核病、梅毒、聚合性痤疮和伴有纤维蛋白样坏死的结节病。当寄生虫稀少或不存在时尤其如此。
