Zusammenfassung
Eine 42-jährige Patientin war wegen Unterleibsschmerzen infolge eines Thailandaufenthaltes
bei V. a. Genitalmykose wiederholt ambulant und stationär behandelt worden. Im Verlauf
traten brettharte, fistulierende, druckschmerzhafte, subkutane Knoten auf. Die stationäre
Aufnahme bei uns erfolgte unter dem V.a. Aktinomykose. Labor und paraklinische Untersuchungen
ergaben im Wesentlichen unauffällige Befunde, die Histologie ließ am ehesten an eine
Tuberkulose denken. Der Nachweis von Drusen gelang ebenso wenig wie der säurefester
Stäbchen. Das nachgewiesene Mykobakterium chelonae wurde vom nationalen Referenzzentrum
Borstel als klinisch nicht relevant eingestuft. Unter hochdosierter Penicillingabe
und topischer Therapie mit Ichthyol kam es jedoch zu einer Befundbesserung, so dass
wir rückblickend von einer atypischen Mykobakteriose unter dem klinischen Bild einer
Tuberculosis subcutanea et fistulosa ausgehen. Die Besserung des klinischen Befundes
könnte möglicherweise auf eine für M. chelonae beschriebene Spontanheilung zurückzuführen
sein.
Abstract
A 42year old woman had been treated several times because of lower abdominal pain
both on an out- and inpatient basis with the presumption diagnosis of a genital mycosis.
In the course hardly indurated, fistulous, subcutaneous nodules occurred with tenderness.
We hospitalized the patient under the presumption of actinomycosis. The laboratory
and paraclinical findings were incospicuous, the histopathologic results corresponded
to cutaneous tuberculosis. Neither drusen nor acid-resisting rod-shaped bacteria could
be proved. The only found Mycobacterium chelonae was classified as non pathologic
by the National Reference Centre Borstel. The efflorescences regressed under high-dose
therapy with penicillin and topical application of ichthyol. We assume that the patient
suffered from an atypical mycobacteriosis (MOTT = Mycobacteria other than tuberculosis)
under the clinical picture of a tuberculosis subcutanea and fistulosa. The recovery
might be based on a spontaneous regression which is described in literature for M.
chelonae in single cases.
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Dr. med. univ. Peter J. Preinfalk
Hautklinik · Klinikum Heilbronn
Am Gesundbrunnen · 74064 Heilbronn
