瘤型麻风伴梅毒非特异性抗体假阳性1例

患者男,46岁,面部、四肢、足侧缘斑块、结节2个月,躯干、四肢暗红色斑疹1个月。面部皮损组织病理示：表皮轻度萎缩,真皮内见由泡沫样组织细胞构成的结节状浸润,与表皮间有无浸润带,抗酸菌染色(4+)。足部皮损组织病理示：表皮轻度萎缩,真皮及皮下脂肪组织内见白色泡沫样组织细胞构成的结节状浸润,与表皮间有无浸润带,抗酸菌染色(4+)。躯干部皮损组织病理示：表皮轻度萎缩,真皮血管周围可见组织细胞、淋巴细胞浸润,部分组织细胞呈泡沫状,抗酸菌染色(2+)。面部皮肤组织涂片,抗酸杆菌阳性(4+)。甲苯胺红不加热血清试验(TRUST)阳性,TRUST半定量1∶1,梅毒螺旋体特异性抗体(TPPA)阴性。诊断：瘤型麻风伴梅毒非特异性抗体假阳性。于当地疾控中心接受麻风联合化疗(MDT-MB)方案治疗好转,目前随访中。     

瘤型麻风1例

患者男,44岁。躯干、四肢红色丘疹、斑块5年。皮肤科情况:躯干、四肢红色丘疹、斑块。皮损处温觉障碍,无明显眉毛脱落及浅表神经粗大。皮损组织病理示:表皮萎缩,真皮内见由泡沫样细胞构成的结节状浸润,与表皮间有无浸润带。抗酸染色找到大量抗酸杆菌(4+)。诊断:瘤型麻风。     

儿童组织样麻风瘤1例

患儿女,12岁。四肢丘疹、结节、斑块6个月。患者既往无麻风接触史。皮肤科情况:四肢见粟米至绿豆大小肤色或淡红褐色丘疹、小结节,左肘关节屈侧、左小腿分别见一3cm×4cm,1cm×2cm大小红褐色斑块,左手背见多个黄豆至鹅蛋大小红褐色不规则斑块,境界清楚。未见丘疱疹、水疱,眉毛无脱落,皮损处痛温觉减退或局部消失。皮损组织病理示:表皮萎缩,表皮下见一无浸润带。真皮内见结节状或大片状梭形或多角形组织样细胞浸润,并见稀疏淋巴细胞分布。抗酸染色可见大量抗酸杆菌(4+)。诊断:组织样麻风瘤。     

组织样麻风瘤1例

患者男,30岁。躯干、下肢散在结节,眉毛稀疏十个月。皮肤科情况:躯干、四肢散在大小不等的结节,双侧眉毛稀疏,双侧眶上神经和耳大神经明显粗大,踝以下感觉减退。皮损组织病理示:表皮萎缩,可见无浸润带,真皮可见团块状组织样细胞浸润,细胞交织排列成席纹状,神经肿大,周围单一核细胞为主的中度浸润,未见典型的泡沫细胞。抗酸染色可见组织细胞内外大量阳性棒状杆菌。诊断:组织样麻风瘤。     

臀部疣状皮肤结核误诊1例

患儿女,10岁,右臀部环状斑块8余年,曾多次误诊为股癣。皮损组织病理示:表皮角化不全,毛囊角栓,表皮假上皮瘤样增生;真皮浅中层弥漫炎细胞浸润,以淋巴细胞为主;真皮内可见上皮样细胞结节,浸润的细胞有淋巴细胞、多核巨细胞及组织细胞等。抗酸染色(-),PPD试验(3+)。诊断:疣状皮肤结核。     

手部疣状皮肤结核1例

患者男,54岁。左手掌及腕部出现疣状结节及斑块10年余。皮损组织病理示表皮角化过度伴角化不全,假上皮瘤样增生,真皮浅层见结核样浸润,无明显干酪样坏死。结核菌素试验弱阳性,抗酸染色(-),皮损组织真菌培养(-)。诊断:疣状皮肤结核。     

瘤型麻风伴Ⅱ型麻风反应误诊为脂膜炎1例

患者男,42岁。全身皮肤结节1年半,加重伴发热2周。曾以脂膜炎治疗无效。双侧眉毛外1/3稀疏,躯干及四肢泛发鲜红或暗红色结节,两侧腓总神经增粗。组织液涂片抗酸杆菌(3+)～(4+)。皮损组织病理示:表皮萎缩,表皮下可见一狭窄的无浸润带,真皮全层及皮下组织均可见弥漫性中性粒细胞浸润,有脓肿及坏死,可见大量泡沫细胞,皮下组织有脂膜炎样改变及血管炎改变。诊断:①瘤型麻风,②Ⅱ型麻风反应。     

瘤型麻风伴Ⅱ型麻风反应误诊1例

患者男,46岁,全身红斑、结节10年,加重1个月。患者曾多次于外院就诊,以"皮炎""泛发性湿疹""结节性红斑"治疗,无明显好转。双侧眉毛、睫毛脱落,全身大小不一红斑、结节,两侧尺神经、左侧腓总神经轻度增粗。皮损组织病理:表皮增生,真皮浅层可见无浸润带,深部血管周围大量组织细胞浸润,其中可见泡沫样细胞抗酸染色阳性。诊断:瘤型麻风伴Ⅱ型麻风反应/麻风结节性红斑。     

界限类偏瘤型麻风误诊1例

患者男,52岁。左手麻木4年,全身丘疹、斑块、结节、双侧脱眉1年,左手畸形3个月。皮损组织病理:表皮萎缩变薄,表皮下无浸润带,真皮层见结节性或弥漫性组织细胞浸润,血管周围及附属器周围见灶性淋巴细胞,抗酸染色阳性。诊断:界限类偏瘤型麻风。     

界线类偏瘤型麻风误诊1例

患者女,26岁。1年前无明显诱因前额、面颊和四肢出现米粒、黄豆大小不等结节,质硬,个别融合,无疼痛和瘙痒。躯干见甲盖大小、类圆形、散在性红斑,无痛痒。曾被误诊为多种疾病并予以相应治疗,疗效不佳。皮损组织病理示:表皮大致正常,真皮层血管、汗腺和神经周围组织细胞浸润,部分细胞泡沫样变,抗酸染色查见抗酸杆菌(+)。诊断:界线类偏瘤型麻风(BL)。     

Sporotrichoid cutaneous infection by Mycobacterium haemophilum in an AIDS patient

We report a case of primary cutaneous infection by Mycobacterium haemophilum after the bite of an aquarium fish in a severely immunodepressed AIDS patient. Clinical features consisted in nodular and ulcerative lesions that followed a sporotrichoid pattern. Histological study of nodular lesions showed a granulomatous dermatitis with numerous acid-fast bacilli. The mycobacterium was identified 3 months later by genetic hybridization from a cultive in solid medium. Combined therapy with isoniazid, rifampin, clarithromycin, ethambutol, amikacin and ciprofloxacin resulted in complete resolution of the lesions. Infection by Mycobacterium haemophilum is a rare mycobacteriosis that usually affects immunodepressed patients. The most common clinical manifestations are cutaneous lesions but the development of sporotrichoid nodular lymphangitis is exceptional.     

Oral lesions in leprosy revisited: a case report

There is a scarcity of the histopathologically proven lesions of leprosy in the oral cavity, in the world literature. A 55-year-old man had come with a complaint of asymptomatic nodular lesions in the oral cavity. Cutaneous lesions and peripheral nerve examination were suggestive of lepromatous leprosy. Histopathologic examination of a nodule on the palate demonstrated diffuse macrophagic granulomas and acid-fast bacilli.     

Lepromatous leprosy and reversal reaction in a Micronesian immigrant

A 25-year-old Micronesian man from the island of Otia developed erythematous plaques on his legs. He was diagnosed with erythema nodosum and treated with systemic prednisone. Two months later, he presented with erythematous nodules on his forehead, cheeks, and chin (Fig. 1). Examination revealed scattered violaceous papules on his chest, arms, forearms, hands, and feet, and deep purple macules on his palms and soles. Laboratory evaluation included negative serologies for human immunodeficiency virus, rapid plasma reagin, and hepatitis A, B, and C. Routine histopathology revealed nodular aggregates of histiocytes, plasma cells, and lymphocytes. Histiocytes showed basophilic clusters of organisms within vacuoles, suggesting globi. Acid-fast stain revealed numerous acid-fast-positive rod-shaped organisms. The bacterial index on the Fite stain was four (bacterial index/Ridley's logarithmic scale, indicating 10-100 bacteria/high power field) (Fig. 2). An acid-fast stain obtained from a smear of tissue was positive for acid-fast bacilli, but no acid-fast bacilli were cultured. After the first day of treatment with dapsone 100 mg, rifampin 600 mg, and clofazimine 50 mg, the patient complained of burning and pain in his ankles and wrists. There was intense erythema within the lesions. Edema developed in his hands and feet. Consultation with the Gillis W. Long Hansen's Disease Center in Carville, Louisiana, recommended prompt treatment with corticosteroids. The edema of the hands and wrists was treated as a type I reversal reaction with prednisone 1 mg/kg/day. Subsequently, the edema and neuralgia quickly resolved in his distal extremities.     

Ⅱ型麻风反应误诊并死亡1例

患者男,19岁。四肢反复出现疼痛性红斑伴发热1月。患者于2006年1～10月先后4次在外院住院治疗。曾诊断为结节性发热性非化脓性脂膜炎、Sweet综合征,并长期使用较大剂量糖皮质激素治疗。最终突发昏迷及消化道出血于同年11月抢救无效死亡。皮损组织病理示:真皮内大量组织细胞、泡沫细胞浸润,并可见较多的中性粒细胞及核尘,部分血管扩张、充血,可见红细胞外溢,切片抗酸染色阳性。最后诊断:界限类偏瘤型麻风伴Ⅱ型麻风反应。     

Aquarium-borne Mycobacterium marinum skin infection. Report of a case and review of the literature

A 33-year-old fish fancier developed a protracted skin infection that ultimately was found to be caused by Mycobacterium marinum. The organism was isolated from the lesion as well as from infected fish taken from his home aquarium. The lesion resolved after a six-week course of oral sulfamethoxazole and trimethoprim. Forty-four additional cases of culture-proved M marinum skin infections acquired from aquariums and reported in the English-language literature are reviewed. Almost universally, the lesions remained circumscribed and were either single nodular (14 patients) or multiple sporotrichoid (31 patients). Diagnosis was supported by acid-fast smears (15 patients) and isolation of the organism from skin lesions (43 patients) or from fish (two cases). In vitro studies, as well as clinical outcomes, suggest sulfamethoxazole-trimethoprim or ethambutol hydrochloride plus rifampin to be the drugs of choice.     

Sarcoidosis subcutánea

—Subcutaneous sarcoidosis is characterized by mobile, painless, limb nodules composed of sarcoidal granulomas within fatty tissue, without epidermal involvement. Although cutaneous involvement is found in about a quarter of patients with sarcoidosis, subcutaneous nodules, which may occur in association with other cutaneous lesions, are rare. Less than 40 cases of subcutaneous sarcoidosis have been published the literature.We here report the case of a 63 year-old woman who presented deep, nodular and subcutaneous plaques in extremities for the last 15 days. Histopathology of the cutaneous lesions revealed noncaseating granulomas in subcutaneous tissue, consistent with subcutaneous sarcoidosis. Special stains failed to show foreign material, fungi or acid-fast organism. Thoracic lymphadenopathia were noted in a chest X-ray. Treatment with steroids during 2 months induced an excellent response.     

Superficial thrombophlebitic tuberculide

BACKGROUND: Tuberculides are the result of immunologic reactions to hematogenously spread antigenic components of Mycobacterium tuberculosis. There are three recognized tuberculides--papulonecrotic tuberculide, erythema induratum of Bazin, and lichen scrofulosorum. In 1997, in Japan, Hara and coworkers reported five patients with what they called "nodular granulomatous phlebitis," which they proposed was a fourth type of tuberculide. We describe a patient who presented with features identical to those reported by Hara et al. in order to draw attention to the previous report and to support the concept of a fourth tuberculide which clinically resembles superficial thrombophlebitis. METHODS: A black South African man presented with cord-like thickening of superficial veins on the antero-medial aspects of the lower legs. Nodular swellings were palpable along the course of these veins. There was no evidence of tuberculosis elsewhere in the body, but the patient had a strongly positive tuberculin reaction. Skin biopsies were performed for histologic examination, culture, and polymerase chain reaction (PCR). RESULTS: Histologic examination showed a granulomatous infiltrate localized to the veins in the subcutaneous fat. Stains for acid-fast bacilli and culture were negative, but PCR was positive for M. tuberculosis DNA. The lesions responded promptly to antituberculous therapy. CONCLUSIONS: Our patient showed features identical to those of cases described by Hara and coworkers and assigned as a fourth type of tuberculide. As the lesions clinically resemble superficial thrombophlebitis, we propose the term "superficial thrombophlebitic tuberculide" rather than "nodular granulomatous phlebitis."     

Sporotrichoid Mycobacterium marinum infection of the face following a cat scratch

Mycobacterium marinum infections in humans uncommonly affect the face and are not known to be associated with cat scratches. We describe a 24-year-old woman who presented with a 3-month history of multiple tender, occasionally discharging cystic nodules involving the left side of her face in a sporotrichoid distribution. She had suffered a cat scratch to her left lower eyelid 3 weeks before the onset of the eruption and owned multiple tropical fish tanks. She was systemically well and had no lymphadenopathy. She had a background history of a 4.5-mm-thick nodular melanoma of her temple treated by wide local excision and negative sentinel lymph node biopsy 4 years prior. Skin biopsies showed multiple variably sized granulomas surrounded by thick cuffs of lymphocytes involving the superficial and deep dermis with no organisms seen on Ziehl–Neelsen, peroidic acid-Schiff and methenamine silver stains. Laboratory investigations showed a mildly raised erythrocyte sedimentation rate but normal full blood count and C-reactive protein. Fluid from the left cheek grew an acid-fast bacillus identified as Mycobacterium marinum . The skin eruption cleared after 5-month treatment with oral clarithromycin 500 mg twice daily and rifampicin 600 mg daily.