An unusual cutaneous infection caused by Mycobacterium marinum.

JMM case reports Pub Date : 2017-04-12 eCollection Date: 2017-04-01 DOI:10.1099/jmmcr.0.005088
Federica Veronese, Elisa Zavattaro, Pamela Farinelli, Enrico Colombo, Paola Savoia
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引用次数: 5

Abstract

Introduction.Mycobacterium marinum is a non-tubercular mycobacterium residing in fresh or salt water (in tropical or temperate areas); it is a fish and human pathogen, and in immunocompromised patients can cause severe cutaneous and subcutaneous infections. Case presentation. A 46-year-old white man who underwent immunosuppressive therapy was admitted to our department in May 2016 for skin lesions previously diagnosed as 'unusual erysipelas'. We rejected the hypothesis of erysipelas, due to the clinical features, and our diagnostic hypotheses were oriented towards sporotrichosis, atypical mycobacteriosis, cutaneous tuberculosis and cutaneous sarcoidosis. Histological examination performed after a skin biopsy was compatible with a diagnosis of sporotrichosis. However, PCR performed on fresh tissue demonstrated the presence of M. marinum. Conclusion. The case reported is interesting for the unusual clinical localization and modality of infection. The patient became infected by contact with contaminated remains or in the sea, in a geographical area not endemic for M. marinum. The previous state of immunosuppression favoured infection; however, the presence of M. marinum in this area suggests a possible tropicalization of the water of the Mediterranean Sea. To our knowledge, this case is the only one reported in the literature with this modality of infection and in that geographical area.

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由海洋分枝杆菌引起的一种不寻常的皮肤感染。
介绍。海洋分枝杆菌是一种存在于淡水或咸水(热带或温带地区)的非结核分枝杆菌;它是一种鱼类和人类病原体,在免疫功能低下的患者中可引起严重的皮肤和皮下感染。案例演示。一名46岁白人男性于2016年5月因既往诊断为“异常丹毒”的皮肤病变接受免疫抑制治疗入住我科。由于临床特点,我们拒绝丹毒假说,我们的诊断假设是面向孢子菌病、非典型分枝杆菌病、皮肤结核和皮肤结节病。皮肤活检后进行的组织学检查与孢子虫病的诊断一致。然而,在新鲜组织上进行的PCR显示海洋分枝杆菌的存在。结论。病例报告是有趣的不寻常的临床定位和感染方式。患者因接触受污染的遗骸或在海洋中,在没有海洋分枝杆菌流行的地理区域中感染。既往免疫抑制状态有利于感染;然而,该地区海洋分枝杆菌的存在表明地中海水域可能出现了热带化。据我们所知,该病例是该地理区域文献中报告的唯一一例具有这种感染方式的病例。
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