Pathology
Images
Atlas of dermatopathology
Josef Feit, Hana Jedličková, Günter Burg, Luděk Matyska, Spasoje Radovanovic et al.
Index
Contents
Authors
ExpSys: non-tumors
ExpSys: tumors
Up
Next
Back
×
+ Introduction
+ Literature
+ Support
+ Skin biopsy
+ Non-tumorous skin diseases
+ Skin tumors
+ Cysts of the skin and subcutis
+ Soft tissue lesions
+ Some lesions of the oral cavity
+ Dermatovenerology
+ Collection of histological slides by prof. Günter Burg
+ Collection of histological slides by prof. Werner Kempf
+ Collection of histological slides of dr. Ram Chandra Adhikari
Diseases caused by atypical mycobacteria
Clinical signs
  • nodules, ulcerations and verrucosities at the site of trauma; slow spread
  • lymphatic and hematogenic spreading
  • “swimming pool granuloma”: infections from swimming pools or fish tanks
  • generalisation in immunodeficiencies (AIDS)
Pictures

Mycobacteriosis: Tuberculosis, Clinical picture (1087)

Histology

Granulomatous inflammation, necroses; staining for mycobacteria similar to tuberculosis

Pictures

Atypical mycobacteriosis, chin: Atypical mycobacteriosis, HE 20x (4416) Atypical mycobacteriosis, Ziehl Neelsen 100x (4418) Atypical mycobacteriosis, Ziehl Neelsen 100x (4419) Atypical mycobacteriosis, Ziehl Neelsen 100x (4420) Atypical mycobacteriosis, Ziehl Neelsen 100x (4422)

Mycobacterium chelonae, pus: Atypical mycobacteriosis, Mykobakterium chelonae, Ziehl Neelsen 100x (5981)

Mycobacterium chelonae, cultivation: Mycobacterium marinum, cultivation, Ziehl Neelsen 40x (6161)

Mycobacteriosis: Mycobacteriosis, HE 60x (6420) Mycobacteriosis, Ziehl Neelsen 60x (6419)

Mycobacteriosis: Mycobacteriosis, skin, Fite 60x (14593) Mycobacteriosis, skin, HE 60x (14594) Mycobacteriosis, skin, HE 60x (14595)

Case study
Atypical mycobacteriosis
MUDr. Hana Jedličková, PhD.
Introduction

The incidence of skin infections caused by atypical mycobacteria is rising. They occur either in predisposed, i.e. immunocompromised individuals, or in case of long lasting contact of infectious agent with the skin.

Cutaneous manifestations are solitary or multiple nodules, pustules, ulcers or plaques. In immunocompetent individuals the disease is localized and sometimes self healing, though in immunocompromised patients the infection can be generalized and life threatening.

Classification

Mycobacteria are acid-fast bacilli. Atypical mycobacteria are facultative human pathogens; they are divided into slow-growing and rapid growing mycobacteria, further into subgroups according to their pigment-forming properties.

Among the most frequent causes of skin diseases are M. marinum (fish tank granuloma), M. chelonae (e.g. catheter infections, surgery complications), M. kansasii, M. ulcerans (Buruli ulcer).

The pathogen can be identified by histopathology (Ziehl Neelsen stain), cultivation under special conditions and PCR (reference laboratories).

History

51-year-old man had a 6-month history of dermatitis on his hands, treated by topical corticosteroids and 3-week history of erythematous nodules on the 3rd and 4th fingers of his right hand. He used medication for hypertension and hyperlipidemia. He was a professional aquarist for many years.

Clinical signs

Two red nodules on the 3rd and 4th finger of the right hand.

Pictures

Atypical mycobacteriosis, fingers: Atypical mycobacteriosis, Clinical picture (6152) Atypical mycobacteriosis, Clinical picture (6153)

Histology

Epidermis showed hyperkeratosis and acanthosis. In the dermis there was a dense lymphocytic infiltrate and epithelioid granulomas with scattered multinuclear giant cells. In the centre of some granulomas were abscesses with numerous neutrophils. Ziehl Neelsen stain was positive with several rod-like microorganisms.

Special studies were performed by prof. Pavlík of the Reference Laboratories of Paratuberculosis and Avian Tuberculosis Mycobacteriology Unit, Veterinary research Institute, Brno. PCR studies were negative. In culture mycobacteria were detected after 9 weeks, which were further identified as Mycobacterium marinum.

Pictures

Atypical mycobacteriosis (Mycobacterium marinum), HE and special staining: Atypical mycobacteriosis, HE 20x (5955) Atypical mycobacteriosis, Mycobacterium marinum, Ziehl Neelsen 100x (5956)

Mycobacterium marinum, cultivation: Mycobacterium marinum, cultivation, Ziehl Neelsen 40x (6161)