Mycobacterium haemophilum infection with prominent facial manifestation mimicking leprosy
Mycobacterium haemophilum infection with prominent facial manifestation mimicking leprosy
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嗜血分枝杆菌感染，具有类似麻风病的明显面部表现
DOI：
10.1111/1346-8138.12948
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
A. Asahina
中科院分区：
文献类型：
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作者：
K. Ishii;N. Ishii;K. Nakanaga;K. Nakano;I. Saito;A. Asahina
嗜血分枝杆菌是一种生长缓慢的非结核分枝杆菌，很少引起人类皮肤感染，特别是在免疫功能低下的患者中。我们最近经历了一位69岁的日本女性，她患有这种感染，一直在接受免疫抑制治疗，治疗复发性类风湿性关节炎。患者面部和四肢出现弥散性斑块和皮下结节，有趣的是，面部表现为明显的“莱昂蒂娜面”外观。活检显示脓肿和肉芽肿性皮炎，累及周围神经束，并存在无数抗酸杆菌，因此需要与瘤型麻风鉴别。M.通过分子表征以及通过用铁补充剂成功培养来鉴定嗜血杆菌。虽然药物敏感性测试表明对同时给予多种抗生素进行治疗的反应性，但需要6个多月才能获得显着改善，我们还采用了同时口服碘化钾和重复手术切除。该病例强调了持续联合治疗对这种罕见感染成功结局的重要性。此外，应用碘化钾治疗分枝杆菌感染需要积累更多病例进行进一步评价。
Mycobacterium haemophilum is a slow‐growing non‐tuberculous mycobacterium that is rarely known to cause human skin infection, particularly in immunocompromised patients. We recently experienced a 69‐year‐old Japanese woman with this infection who had been under immunosuppressive treatment for recalcitrant rheumatoid arthritis. The patient showed disseminated erythematous plaques and subcutaneous nodules on the face and extremities, and interestingly, the face manifested with a striking “facies leontina” appearance. Biopsy revealed abscess and granulomatous dermatitis with the involvement of peripheral nerve bundles and the presence of innumerable acid‐fast bacilli, thus necessitating differentiation from lepromatous leprosy. M. haemophilum was identified by molecular characterization as well as by successful culture with iron supplements. Although drug susceptibility testing indicated responsiveness to multiple antibiotics administrated simultaneously for the treatment, it took over 6 months to achieve significant improvement, and we also employed concurrent oral potassium iodide administration and repeated surgical excision. This case highlights the importance of continuous combination therapy for successful outcome in this rare infection. Furthermore, application of potassium iodide for mycobacterial infection warrants further evaluation by accumulating more cases.