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- 右颊部皮肤活检
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本帖最后由 liminyu 于 2013-03-11 13:08:36 编辑
Ajib raised a good question. My first impression is to rule out Leishmaniasis.
Cutaneous leishmaniasis is the most common form and the patient's clinical presentation is compatible. But it's uncommon in China, rarely reported in XinJiang. Anything significant about the patient's travel history?
The parasites are round to oval basophilic structures, 2–4 µm in size. They have an eccentrically located kinetoplast. Giemsa stain highlights them.
See the picture:
http://wellcomeimages.org/indexplus/result.html?*sform=wellcome-images&_IXACTION_=query&%24%3Dtoday=&_IXFIRST_=1&%3Did_ref=W0003420&_IXSPFX_=templates/t&_IXFPFX_=templates/t&_IXMAXHITS_=1
Morphologically, they need to be distinguished from histoplasmosis. The lack of a capsule is
helpful in distinguishing leishmaniasis from Histoplasma capsulatum. But histoplasmosis is less likely given the patient's long history and assumed lack of systemic presentation.
That being said, these intracytoplasmic inclusion bodies don't necessarily represent microorganisms. A recent case of mine had tons of intracellular inclusion bodies in the background of granulomatous inflammation. But all special stains were negative. It turned out to be a reactive changes after years of inflammation.
- 由于我对许多疾病的中文名称不熟悉， 我只好用英文表达。 请谅解。
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本帖最后由 琴与流星 于 2013-03-12 18:33:00 编辑
应该不是微生物，大小太不一致，而利什曼小体大小多一致性并相对较小，炎症明显，浆细胞丰富，考虑为浆细胞分泌的免疫球蛋白小体或浆细胞坏死后残留的胞浆碎片，在肠道慢性炎症性病变中常有这种小体出现。
