PDF(Pubmed)
Abstract：
Pathogenic and free-living Acanthamoeba are widely distributed in the environment and have been reported to cause keratitis and universally fatal encephalitis. Primary cutaneous acanthamoebiasis caused by Acanthamoeba is exceedingly rare and presents as isolated necrotic cutaneous lesions without involvement of the cornea or central nervous system. Cutaneous acanthamoebiasis often occurs in immunocompromised patients and is likely overlooked or even misdiagnosed only by cutaneous biopsy tissue histopathological analysis. Here, we report a HIV-infected 63-year-old female with oral leukoplakia for 4 months and scattered large skin ulcers all over the body for 2 months. The cause of the cutaneous lesions was unclear through cutaneous specimens histopathological analysis, and subsequently Acanthamoeba were detected by metagenomic next-generation sequencing (mNGS), which may be the cause of cutaneous lesions. Based on the mNGS results, a pathologist subsequently reviewed the previous pathological slides and found trophozoites of Acanthamoeba so that the cause was identified, and the skin ulcers improved significantly after treatment with multi-drug combination therapy. Acanthamoeba is also a host of pathogenic microorganisms. The presence of endosymbionts enhances the pathogenicity of Acanthamoeba, and no other pathogens were reported in this case. mNGS is helpful for rapidly diagnosing the etiology of rare skin diseases and can indicate the presence or absence of commensal microorganisms.
摘要：
致病性和自由生活的棘阿米巴在环境中广泛分布，据报道可引起角膜炎和普遍致命的脑炎。由棘阿米巴引起的原发性皮肤棘阿米巴病极为罕见，表现为孤立的坏死性皮肤病变，而不涉及角膜或中枢神经系统。皮肤棘阿米巴病通常发生在免疫功能低下的患者中，仅通过皮肤活检组织病理学分析可能会被忽视甚至误诊。这里,我们报告了一名感染HIV的63岁女性，患有口腔白斑4个月，并散布在全身的大面积皮肤溃疡2个月。通过皮肤标本的组织病理学分析，皮肤病变的原因尚不清楚，随后通过宏基因组下一代测序（mNGS）检测到棘阿米巴，这可能是皮肤损伤的原因。根据mNGS结果，病理学家随后回顾了以前的病理切片，发现了棘阿米巴滋养体，从而确定了病因，多药联合治疗后皮肤溃疡明显改善。棘阿米巴也是病原微生物的宿主。内共生体的存在增强了棘阿米巴的致病性，在这种情况下，没有其他病原体的报道。mNGS有助于快速诊断罕见皮肤病的病因，并可以指示共生微生物的存在或不存在。
