以皮肌炎样表现为特征的血行播散性结核--附3例尸检

目的：为了避免临床误诊，对结核病的肌肉病变特点进行探讨。方法：复习２５例经尸检证实为急／亚急性血播散性结核的病例，其中３例临床上主要表现为皮肤和肌肉损害，分别在患者生前诊断为皮肌炎（２例）和多发性硬化症（１例）。对其骨骼肌进行详细的镜下观察。结果：四肢肌、膈肌、食道和喉的横纹肌均有程度不同的变性、坏死和淋巴细胞浸润，表现为：（１）肥大或萎缩；（２）嗜酸性、玻璃样和絮状变性；（３）溶解和凝固性坏死；

Hematogenous disseminated tuberculosis displaying dermatomyositis:An autopsy observation of 3 cases

Purpose The morphological characteristics of muscular pathologic change of tuberculosis were studied to avoid clinical misdiagnosis. Methods Twenty five cases of acute/subacute hematogenous disseminated tuberculosis confirmed by autopsy were reviewed,in which 3 patients had main symptoms of the skin and muscular injury clinically. They were diagnosed as dermatomyositis(2 cases) and multiple sclersis(1 case) respectively before they died. Skeletal muscles of the 3 cases were observed carefully by microscope. Results The muscles of limbs, diaphragm, esophagus and larynx showed degeneration,necrosis and lymphocytic infiltration in different degree:(1)hypertrophy or atrophy;(2)acidophilic hyline and flocculent degeneration;(3)liquefaction and coagulation necrosis; (4)aggregation of the phagocyte;(5)focal lymphocytic infiltration. The smooth muscles of esophagus, stomach, intestine and bladder had contraction band necrosis. Conclusions The skeletal muscular injury is possibly relevant to the tuberculous autoimmune reaction. The contraction band necrosis is not a specific pathologic change of the diseases, and possibly a morphological manifestation of muscle in preterminal stage.