A Refractory Granuloma of Mycobacterial Infection in a Digit-A Case Report

手指頑固性肉芽腫隱藏分枝桿菌感染之個案報告

顏伯璁(Po-Tsung Yen) ； 莊世松(Shih-Sung Chuang) ； 李彥勳(Yen-Hsun Lee) ； 劉澄(Cheng Liu) ； 黃國峯(Kuo-Feng Huang) ； 林聿山(Yu-Shan Lin) ； 陳俊嘉(Chun-Chia Chen)

《臺灣整形外科醫學會雜誌》 19卷1期 (2010/03) Pp. 53-59

https://doi.org/10.7096/TJTSPS.201003.0053

摘要

背景：
分支桿菌感染並不常見，診斷上常因為缺乏臨床上的懷疑而導致延遲治療。
目的及目標：
希望藉由此病例報告分享我們診斷上遭遇的困難及後續的治療方式。
材料與方法：
一位19歲健康男性先前曾因右手小指遭穿刺傷後引發肉芽腫，在皮膚科醫師切除之後又復發故轉而求助整形外科。
結果：
肉芽腫被切除，另因小指伸指肌腱亦被部分侵犯故部分切除並直接將肌腱縫合。病理學顯示慢性肉芽腫發炎併乾酪樣壞死及Langhans 氏細胞。抗酸性染色試驗呈陽性反應。分枝桿菌聚合酶連鎖反應顯示Mycobacterium tuberculosis complex感染。故於術後開始使用抗分枝桿菌藥物。10個星期後追蹤並無復發跡象且右手小指功能良好。病人仍於門診追蹤並持續使用抗分枝桿菌藥物。
結論：
對於手指頑固性肉芽腫可能潛藏分枝桿菌感染吾人應該更加小心以避免感染擴大危及手指功能。手術清除病灶並合併使用抗分枝桿菌藥物是主要的治療方式。

並列摘要

Background:
Mycobacterial infection is rarely common. The treatment is often delayed due to lack of clinical suspicion which would lead to the special diagnostic procedures.
Aim and Objectives:
We would like to highlight the unusual infection and difficulty of diagnosis as well as the treatment modalities.
Materials and Methods:
We report a 19-year-old healthy male with a precedent history of a penetrating injury to the right little finger. The next day he developed finger swelling, followed by a granuloma. Recurrence on the dorsal aspect of the proximal interphalangeal (PIP) joint of right little finger was encountered after local excision by a dermatologist.
Results:
The granuloma, involving the extensor tendon, was widely excised and the tendon was directly repaired. The histopathology revealed chronic granulomatous inflammation with caseous necrosis and Langhans cells. The Ziehl-Neelsen stain was positive. The polymerase chain reaction for the detection of Mycobacterium tuberculosis (TB-PCR) test showed positive Mycobacterium tuberculosis complex infection. The anti-mycobacterial agents were started postoperatively. There is no recurrence in 10-week follow-up and the range of motion of right little finger is satisfactory. The patient remains followed in the outpatient department.
Conclusion:
We should keep in mind that a refractory ulcer or granuloma may be caused by mycobacterial infection. The treatment is usually surgical debridement followed by anti-mycobacterial therapies for a period of 6 months.

並列關鍵字

refractory granuloma ； mycobacterial infection