免疫抑制患者的脓肿分枝杆菌皮肤感染:一种非典型病原体的病例报告。

IF 0.5 4区 医学 Q4 ORTHOPEDICS
Caden Carver, Jigar Patel, Dylan Mariano, Mattie Krause, Evelyn Heigh-Rosen
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引用次数: 0

摘要

复合脓肿分枝杆菌(MAbc)是一种生长迅速的非结核分枝杆菌,是皮肤感染日益普遍的病因。本报告描述了 MAbc 的一种非典型表现,以提高医生对该病原体的认识。一名免疫力低下的 69 岁女性在被昆虫叮咬后,右下肢出现单发、不愈合的溃疡,病史长达 4 个月。初步诊断为蜂窝组织炎,口服阿莫西林/克拉维酸和外用莫匹罗星后病情未见好转,对病灶进行活检和培养后发现了 MAbc。显微镜检查显示为反应性皮肤炎症,无恶性证据。耐酸细菌(AFB)染色阴性,组织学检查未发现肉芽肿。在等待药敏试验结果期间,患者开始服用克拉霉素和强力霉素。最终培养结果显示,MAbc对阿米卡星、头孢西丁和克拉霉素敏感。不幸的是,还没来得及改变抗生素疗法,患者就去世了。与现有文献相比,单发下肢溃疡的病例并不多见。本病例发生在疑似昆虫叮咬后,而非器械治疗后。此外,该病例的 AFB 染色阴性,组织学分析也未发现肉芽肿。由于患者死亡,无法对治疗效果进行评估。关于 MAbc 特征的现有文献很少。大多数病例表现为多发性丘疹、结节和脓肿,AFB 染色阳性,并伴有肉芽肿;根据宿主的免疫状态,也可能存在偏差。考虑到脓毒症甲虫的高度耐药性,及时诊断和治疗至关重要。要做到这一点,临床医生必须对任何经初步治疗无效的慢性不愈合伤口保持高度的临床怀疑。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Mycobacterium abscessus Cutaneous Infection in the Immunosuppressed: A Case Report on an Atypical Pathogen.

Mycobacterium abscessus complex (MAbc) is a rapidly growing nontuberculous mycobacterium that represents an increasingly prevalent cause of skin infections. This report describes an atypical presentation of MAbc to heighten physician awareness of the pathogen. A 69-year-old woman with immunocompromised status presented with a 4-month history of a solitary, nonhealing ulcer on her right lower extremity after an insect bite. After no improvement following oral amoxicillin/clavulanate and topical mupirocin for the initial diagnosis of cellulitis, biopsy and culture of the lesion revealed MAbc. Microscopic examination revealed reactive cutaneous inflammation without evidence of malignancy. Acid-fast bacteria (AFB) stain was negative, and no granulomas were noted histologically. Clarithromycin and doxycycline were initiated while awaiting susceptibility testing results. Final culture showed MAbc sensitive to amikacin, cefoxitin, and clarithromycin. Unfortunately, before antibiotic therapy could be modified, the patient died. The presentation of a solitary lower-extremity ulcer is rare compared with current literature. This case occurred after a suspected insect bite rather than instrumentation. In addition, this case demonstrated negative AFB stain and absence of granulomas on histologic analysis. The patient's death did not allow for evaluation of treatment efficacy. Existing literature characterizing MAbc is sparse. Most cases present as multiple papules, nodules, and abscesses with positive AFB staining and granulomas; it is possible for deviations to exist depending on host immune status. Considering the highly drug-resistant nature of M abscessus, prompt diagnosis and treatment are crucial. For this to occur, clinicians must maintain high clinical suspicion for M abscessus infection in any chronic, nonhealing wound failing to respond to initial treatment.

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来源期刊
CiteScore
1.10
自引率
0.00%
发文量
128
审稿时长
6-12 weeks
期刊介绍: The Journal of the American Podiatric Medical Association, the official journal of the Association, is the oldest and most frequently cited peer-reviewed journal in the profession of foot and ankle medicine. Founded in 1907 and appearing 6 times per year, it publishes research studies, case reports, literature reviews, special communications, clinical correspondence, letters to the editor, book reviews, and various other types of submissions. The Journal is included in major indexing and abstracting services for biomedical literature.
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