两性霉素B脂质体腔内注射治疗念珠菌性肝脓肿

应用两性霉素B脂质体(抑霉泰，L-AMB）脓腔内注射治愈1例白念珠菌引起的肝脓肿、患儿男，12岁。因外伤手术后发现右肝前叶脓肿入院。先后行11次肝脓肿穿刺液真菌镜检和培养，证实为白念球菌感染。在超声引导下脓腔内注射L-AMB，每周2次，首次0.8mg，以后依次为1.0、2．0．3．0、4．0mg，共注射9次，总量30.8mg治疗后病情迅速好转，患者经脓肿穿刺液真菌镜检、培养转阴后出院。随访3年，未见复发。     

美容注射术后皮肤脓肿分枝杆菌感染临床分析

对2018年12月至2019年12月我院确诊的7例皮肤脓肿分枝杆菌感染患者的临床资料进行回顾性分析。本文患者均在非正规医院行美容注射术,术后注射部位都发生脓肿分枝杆菌感染。7例患者均为多发皮损,且为美容注射后发病,表现为红斑、结节、脓肿、溃疡。病理呈感染性肉芽肿改变。6例皮损组织脓液培养结果为脓肿分枝杆菌,1例行组织PCR扩增提示脓肿分枝杆菌感染。诊断为皮肤脓肿分枝杆菌感染。给予克拉霉素、利福平、左氧氟沙星治疗,皮损均消退,随访半年无复发。     

高IgE综合征临床表现及与特应性皮炎的鉴别诊断

高IgE综合征(hyper-immunoglobulin E syndrome,HIES)是临床少见的以免疫和结缔组织紊乱为特点的原发性遗传免疫缺陷病,临床表现主要为慢性湿疹样皮炎,伴血清IgE水平及嗜酸粒细胞计数的持续升高、严重反复的细菌或病毒感染、骨骼发育异常等表现,部分患者早期有并发恶性肿瘤的可能。HIES属于少见病,临床医师对本病的认识不足,而特应性皮炎(atopic dermatitis,AD)和HIES的主要临床表现、实验室检查结果等有很多相似,HIES容易被漏诊或误诊为AD。该文通过归纳分析高IgE综合征的临床表现和实验室检查指标特征,比较与AD的异同,可提高临床医生对HIES的认识以及对这两种疾病的鉴别诊断能力。     

肝移植术后并发脑感染的MRI研究

目的探讨肝移植术后并发脑感染特异性表现,为临床肝移植术后存活率以及临床治疗提供有价值的指导意义。方法回顾性分析肝移植术后并发脑感染临床及磁共振成像（MRI）影像资料19例,临床以头痛、头晕、发热及呕吐为主要临床表现。结果MRI显示,19例中大片状异常信号2例,脑脓肿壁形成17例,可见一光滑的低信号“暗带”。增强扫描片状强化1例,厚度均匀的环形强化17例,其中强化环旁可见云絮状强化区4例。脓肿腔DWI显示为高信号。结论肝移植术后并发脑感染的MRI影像表现具有特异性,正确识别这些MR表现特征可为肝移植术后临床治疗提供重要的指导意义,从而提高肝移植预后。     

面部脓肿分枝杆菌感染2例

报告2例美容注射手术后面部感染脓肿分枝杆菌.例1.女,32岁.肉毒素注射1周后面部出现多发脓肿.例2.女,35岁.面部自体脂肪填充术2周后注射部位出现多发性脓肿.通过对2例患者脓液行各项检查鉴定出脓肿分枝杆菌,证实2例患者均为脓肿分枝杆菌感染.例1治疗3个月后基本痊愈,例2仍在随访中.     

增殖型坏疽性脓皮病一例

患者男，42岁。因胸部及下肢反复脓肿3年，出现溃烂伴疼痛1年入院。3年前开始无明显诱因下反复出现面部脓肿，脓液排出后自行消退，故未予重视。2010年2月左侧锁骨区及胸部出现类似脓肿，脓液排出后表面溃烂，并迅速扩大，疼痛明显。患者于当地医院就诊，给予诺美沙星、林可霉素等治疗，疗效不佳，后使用草药（具体不详）口服和外敷后逐渐好转，留有暗红色瘢痕，     

儿童过敏性紫癜并发肠套叠诊疗分析

目的：分析过敏性紫癜并发肠套叠的临床特征。方法：搜集2011年9月至2018年4月就诊于我院皮肤科及小儿外科的8例过敏性紫癜并发肠套叠患儿临床资料，包括临床表现、辅助检查、治疗方法及治疗效果。结果：8例患儿经腹部B超或CT确诊。2例在B超监视下水压灌肠复位后肠套叠缓解，3例剖腹探查手法复位后缓解，3例存在肠坏死行肠切除术。结论：过敏性紫癜并发肠套叠以小肠为主，早期诊断困难，对于腹型过敏性紫癜患儿应密切观察腹部症状体征变化。     

原发性骨髓纤维化并发增殖型坏疽性脓皮病

报告1例原发骨髓纤维化伴增殖型坏疽性脓皮病。患者男，63岁。左颈后反复肿块伴疼痛2年余。皮肤科检查：左颈后可见一紫红色肿块，中央见深在性溃疡，表面见大量脓性分泌物，边缘隆起，压痛阳性，周围见炎性丘疹及丘脓疱疹。皮损病理组织：真皮及毛囊周围可见大量中性粒细胞浸润，局部中性白细胞聚集形成脓肿。骨髓组织病理符合原发性骨髓纤维化。诊断：原发性骨髓纤维化并发增殖型坏疽性脓皮病。予小剂量糖皮质激素治疗后皮损逐渐消退，停药后仍有复发。     

穴位埋线致脓肿分枝杆菌感染北大核心CSCD

报告1例穴位埋线致脓肿分枝杆菌感染。患者女,34岁。因躯干与四肢红斑、结节伴痒痛1个月余就诊。患者1个月前至非医疗机构行穴位埋线后埋线部位出现结节、脓肿,脓液抗酸染色阳性,组织病理学检查呈感染性肉芽肿改变,分枝杆菌培养阳性,DNA测序符合脓肿分枝杆菌,诊断为脓肿分枝杆菌感染。予以利福平、莫西沙星、克拉霉素抗感染治疗1年,脓肿消退遗留色素沉着和瘢痕。     

原发性淋菌性皮肤脓肿6例报告

男性淋球菌感染最常发生的是急性淋菌性尿道炎，它也可以侵入皮下组织引起脓肿^[1]。但临床上少见。我们在近2年中治疗原发性淋菌性皮肤脓肿6例，现报告如下     

A young man with hyperimmunoglobulin-E syndrome and IgA and IgG deficiencies

Hyperimmunoglobulin E syndrome (HIES) with recurrent infection is a rare primary immunodeficiency characterized by the clinical triad of recurrent staphylococcal abscesses, cyst-forming pneumonia and an elevated serum immunoglobulin (Ig)E level. We report an 18-year-old man with recurrent chest infections, skin infections and dermatitis. On examination, he had the characteristic facies of HIES: high arched palate, webbing between his thumb and index finger bilaterally, and extensive scarring from multiple staphylococcal skin abscesses. He had an elevated IgE level of 14 300 kU/L. IgA and IgG deficiencies were also identified, which are rare associations of this syndrome and complicated the patient's treatment. The coexistence of HIES, IgA and IgG deficiencies has, to our knowledge, not been reported previously in the literature.     

HYPER IgE SYNDROME WITH UMBILICAL HERNIA

Hyper IgE Syndrome (HIES) is a rare multi system genetic immunodeficiency disorder, with immunological and non-immunological features. Immunolgical features are 1) Recurrent cutaneous abscesses, 2) Atopic dermatitis like lesions, 3) Sino pulmonary infections, 4) Elevated serum IgE levels and 5) Abnormal neutrophil chemotaxis. Non immunological features include cranio facial and skeletal abnormalities. We are reporting a girl with classical features of HIES with umbilical hernia with her younger brother suffering from right sided inguinal hernia, as both herniae are hitherto unreported in patients with HIES.     

Abscess resulting from Mycobacterium kansasii in the left thigh of AIDS patient

A case of abscess resulting from Mycobacterium kansasii, in the left thigh of a 53-year-old woman infected with the Human Immunodeficiency virus, is reported. Curiously, there was no pulmonary or systemic involvement as is usual with these Mycobacterium infections. The patient had CD4 T lymphocyte count of 257 cells/µL and a viral load of 60,154 copies. Despite presenting a relatively preserved immunity, the patient also presented Criptococcic meningoencephalitis and Esophageal candidiasis. The patient responded satisfactorily to treatment for infections and after 51 days was discharged.     

Nocardiosis in a patient with pemphigus foliaceus treated with rituximab

Rituximab is a chimeric human/murine monoclonal anti‐CD20 antibody. This agent is an effective therapeutic option in severe types of pemphigus. However, rituximab may cause opportunistic infections if used in immunosuppressed patients. We reported a case of diffuse Nocardia infection following rituximab treatment in pemphigus foliaceus. Rheumatoid arthritis protocol applied in our patient. Rituximab was used at a dose of 1000 mg every 2 weeks. Because the disease was not adequately controlled, rituximab treatment was administered six times every 15 days. One week after the sixth dose of the rituximab, she presented lassitude and multiple palpable masses in soft tissue of the upper extremity. Thereafter, the aspirate culture of the abscess on the left shoulder was taken and confirmed to be disseminated nocardiosis. She was treated with linezolid and meropenem for 1 month; however, amikacin was added because the patient did not respond adequately to linezolid and meropenem therapy. The patient died of cardiac arrest because of her comorbidities. In this case, prolonged administration of rituximab therapy may have caused the development of nocardiosis. Therefore, all patients should have a sensible balance of risk and benefit, considering the use of rituximab.     

Supportive Immunglobulingabe beim metastasierten Melanom unter Polychemoimmuntherapie nach dem „Legha‐Protokoll”

Summary: Background and Objective: Metastatic malignant melanoma as one of the most aggressive tumors has got a new and promising therapy option with the polychemoimmunotherapy according to “Legha's protocol” (5 – 7). Facing the relatively high toxicity of this therapy, especially the high rate of infections of 49 % ( 8 ), we decided to perform a supportive treatment with intravenous IgM‐enriched immunoglobulins in order to avoid infections.
Patients/Methods: From 1998 to 2002 we treated 34 patients with metastatic malignant melanoma with the polychemoimmunotherapy according to “Legha's protocol”. Four days after each course (except the first one) patients intravenously got IgM‐enriched immunoglobulins (5 ml/kg, i. e. 250 mg /kg).
Results: Out of 34 patients three patients suffered from different infections during the polychemoimmunotherapy: One patient developed a labial herpes infection after each course, another one a subcutaneous abscess on her forearm after the third course and the third patient had a gluteal abscess after the first course, that means before getting immunoglobulins. In comparison with the infection rate of 49 % given in the literature our observed infection rate as a side effect of Legha's therapy is very low (8,8 %) when combined with supportive immunoglobulins.
Conclusions: The supportive treatment with IgM‐enriched immunoglobulins during the polychemoimmunotherapy according to “Legha's protocol” can significantly reduce the rate of opportunistic infections in these secundarily immunosuppressed patients.     

Concurrent Drug-Induced Linear Immunoglobulin A Dermatosis and Immunoglobulin A Nephropathy

Diseases associated with immunoglobulin A (IgA) antibody include linear IgA dermatosis, IgA nephropathy, Celiac disease, Henoch-Schönlein purpura, etc. Although usually idiopathic, IgA antibody is occasionally induced by drugs (e.g., vancomycin, carbamazepine, ceftriaxone, and cyclosporine), malignancies, infections, and other causes. So far, only a few cases of IgA bullous dermatosis coexisting with IgA nephropathy have been reported. A 64-year-old female receiving intravenous ceftriaxone and metronidazole for liver abscess had purpuric macules and papules on her extremities. One week later, she had generalized edema and skin rash with bullae and was diagnosed with concurrent linear IgA dermatosis and IgA nephropathy. After steroid treatment, the skin lesion subsided within two weeks, and kidney function slowly returned to normal. As both diseases occurred after a common possible cause, we predict their pathogeneses are associated.     

Hyperimmunoglobulin E syndrome: two cases and a review of the literature

Hyperimmunoglobulin E syndrome (HIES) is a rare immunodeficiency associated with elevated serum IgE levels, eczematous skin, recurrent cutaneous infections, and distinctive musculoskeletal features. We report two cases seen at our institution and review the current literature. Patient 1 was an 18-month-old African American boy with recurrent staphylococcal cold abscesses, pneumonia, and bacteremia. He had severely eczematous skin, ultimately complicated by eczema herpeticum. After treatment of systemic infections with culture-directed antibiotics, a brief course of cyclosporine, 5 mg/kg, improved the dermatitis and allowed transition to long-term therapy with oral trimethoprim-sulfamethoxazole. Patient 2 was a 15-year-old Caucasian boy with long-standing HIES. He has been maintained on a regimen of interferon gamma injections given 3 times weekly and monthly intravenous immunoglobulin since the age of 3 years, prophylactic antibiotics, and low-dose fluconazole. He has occasional episodes of cold abscesses and sinusitis, but has had excellent control since institution of this regimen and has not experienced any adverse effects.     

Immunosuppression in men with bowenoid papulosis

The immune status of four men with bowenoid papulosis was evaluated. Each case had been refractory to multiple methods of treatment. Three of the men had other infections and demonstrated a depletion of T4-helper cells. Two of these patients were anergic on skin testing, and the third showed weak reactivity. The fourth patient, who had no evidence of additional infections, had a normal T4 value and T4/T8 ratio, but was anergic on skin testing. All the men were serologically negative for human immunodeficiency virus antibodies. One of the immunosuppressed patients developed squamous cell carcinoma of the tongue, which, along with his bowenoid papulosis, contained human papillomavirus 16 DNA. We suggest that patients with persistent bowenoid papulosis be investigated for altered immune status and followed up as potential candidates for the development of epithelial malignant neoplasms.