類似結締組織疾病的嗜血分枝桿菌感染——病例報告

Mycobacterium Haemophilum Infection Mimicking Connective Tissue Diseases － A Case Report

嗜血分枝桿茵（Mycobacterium haemophilum）近來已被認為是可在免疫力低下的病人引發感染的一種病原菌。疾病的表現主要是以皮膚病變、關節炎及骨髓炎為主，但是也有一些病例報告會侵犯肺部。建議的治療為合併三種抗生素，分別是macrolide, rifampin及quinolone。另外，此種病菌亦會侵犯健康的小孩而引發頸部、下頷部及肺門周圍的淋巴腺炎，僅切除受侵犯的淋巴腺即有很好的療效。本篇報告描述一位罹患嗜血分枝桿菌感染的婦女，其初始表現為雷諾氏現象、皮膚病變及血清中出現自體免疫抗體，而被當成結締組織疾病治療，但對類固醇的反應並不理想。最後皮膚切片的聚合？鏈反應（polymerase-chain reaction）確診為嗜血分枝桿菌感染，而給予上述三種抗生素治療，然成效不彰。所以，之後又投予doxycyclin與amikacin並施行皮膚潰瘍的清創術。然而治療過程並不順利，多次併發敗血症，最後因敗血性休克而死亡。

Mycobacterium haemophilum has recently been recognized as a pathogenin immunocompromised patients. Disease manifestations have been predominantly cutaneous lesions, arthritis and osteomyelitis, but a few cases with lung involvement have been described. A 3-drug regimen that contains a macrolide, a rifampin, and a qui no lone was recommended. Moreover, disease caused by this organism has also occurred in some healthy children, where manifestations are cervical, submandibular, and perihilar adenitis, and response to excision of affected lymph nodes only is well. We report a woman with M. haemophilum infection, presenting with Raynaud's phenomenon, cutaneous lesions and autoantibodies, and connective tissue diseases were ever considered. The response to corticosteroid was not satisfactory. M. haemophilum was finally identified by polymerase-chain reaction of skin biopsy. Rifampin in combination with ciprofloxacin and clarithromycin were prescribed initially. Doxycyclin and amikacin were added later and debridement of ulcers was undertaken owing to poor response to previous treatment. However, the clinical course was complicated with repeated episodes of sepsis and she succumbed to profound septic shock at the end.