Perianal ulceration as primary presentation in a patient with disseminated multi‐drug resistant tuberculosis
Perianal ulceration as primary presentation in a patient with disseminated multi‐drug resistant tuberculosis
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DOI：
10.1111/ddg.14031
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发表时间：
2020-02
期刊：
影响因子：
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通讯作者：
J. Strobl;A. Salat;W. Bauer;G. Stary
中科院分区：
文献类型：
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作者：
J. Strobl;A. Salat;W. Bauer;G. Stary
肛门生殖器结核是一种极为罕见的皮肤结核分枝杆菌感染的表现，仅有0.001%的病例出现这方面的症状[1-3]。虽然中欧的结核病患病率相对较低，每10万人中有6-10例，但据估计，世界上三分之一的人口潜伏感染结核杆菌[4，5]。皮肤结核可通过血液传播或直接接种分枝杆菌[6]发生；肛门区域可通过这两种方式受到影响[7]。一名42岁的高加索男性被转诊到性传播感染(STI)门诊中心，并伴有疼痛的肛周溃疡。患者报告了反复咳嗽，他将其归因于大量吸烟(每天40支)，并在其他方面看起来很健康。在过去的两年里，这名患者从未出过欧洲。肛周溃疡已经持续了12个月以上。先前在另一家医院进行的肛周溃疡皮肤活检的组织病理学检查显示非特异性假上皮瘤性增生。肛周病变表现为边界清晰的溃疡，边缘隆起，中央有侵蚀和纤维蛋白涂层[8，9](图1)。病人发热，看起来像是在临床信函中。
Anogenital tuberculosis (TB) is an exceedingly rare presentation of cutaneous Mycobacterium tuberculosis (MTB) infection with only 0.001 % of all TB cases presenting with symptoms in this area [1–3]. While the prevalence of TB is comparatively low with 6–10 cases per 100,000 in Central Europe, one third of the world’s population is estimated to be latently infected with MTB [4, 5]. Cutaneous involvement of TB may occur via hematogenous dissemination or direct inoculation of mycobacteria [6]; the anogenital region can be affected in both ways [7]. A 42-year old Caucasian male was referred to the outpatient center for sexually-transmitted infections (STIs) with painful perianal ulcers. The patient reported a recurrent cough, which he attributed to heavy smoking (40 cigarettes per day), and appeared in an otherwise healthy condition. The patient had not traveled outside Europe within the previous two years. Perianal ulcers had persisted for more than twelve months. A previous histopathological workup of a skin biopsy from the perianal ulceration at another hospital revealed nonspecific pseudoepitheliomatous hyperplasia. The perianal lesion appeared as a sharply demarcated ulcer with raised margins, central erosions and fibrin coatings [8, 9] (Figure 1). The patient was afebrile and appeared to be in Clinical Letter