中国麻风皮肤病杂志 ›› 2026, Vol. 42 ›› Issue (8): 594-596.doi: 10.12144/zgmfskin202608594

• 病例报告 • 上一篇    下一篇

堪萨斯分枝杆菌感染合并噬血细胞综合征与重症多形红斑型药疹一例

朱仁衡,戚欣雨,杨定彬,黄淑琼   

  1. 乐山市人民医院，皮肤科，四川乐山，614000
  • 出版日期:2026-08-15 发布日期:2026-08-03

Mycobacterium kansasii infection complicated with hemophagocytic lymphohistiocytosis and severe erythema multiforme drug eruption: a case report

ZHU Renheng, QI Xinyu, YANG Dingbin, HUANG Shuqiong   

  1. Department of Dermatology, People's Hospital of Leshan, Leshan 614000, China
  • Online:2026-08-15 Published:2026-08-03

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摘要： 患者，男，35岁。反复高热3月余，全身红斑水疱伴瘙痒2天，尼氏征（+）。既往多次查血示血细胞减少、肝功能异常，肺部检出堪萨斯分枝杆菌。经多种抗感染药物治疗效果不佳并出现皮肤黏膜损害，入院后诊断重症多形红斑型药疹，予糖皮质激素、IVIG及对症支持治疗后皮损好转，但糖皮质激素减量后再次高热，患者要求出院，1个月后死亡。结合患者发热≥38.5℃、脾肿大、血细胞减少、高甘油三酯血症及铁蛋白＞1650 ng/mL，最终确诊噬血细胞综合征（HLH）。本病例提示堪萨斯分枝杆菌感染可诱发噬血细胞综合征，重症多形红斑型药疹与噬血细胞综合征并存时病情凶险，临床对长期发热伴肝损伤、血细胞减少及铁蛋白显著升高者需警惕噬血细胞综合征，尽早识别并规范干预对改善预后至关重要。

关键词: 堪萨斯分枝杆菌, 重症多形红斑型药疹, 噬血细胞综合征

Abstract: A 35-year-old male patient presented with recurrent high fever for more than 3 months and generalized erythema, blisters, and itching for 2 days, with a positive Nikolsky's sign. Previous examinations revealed cytopenia and abnormal liver function; Mycobacterium kansasii was detected in the lungs. The patient showed poor response to multiple anti-infective agents and developed mucocutaneous lesions. After admission, he was diagnosed with severe erythema multiforme drug eruption. Treatment with glucocorticoids, intravenous immunoglobulin (IVIG), and supportive care resulted in improvement of skin lesions; however, high fever recurred following glucocorticoid tapering. The patient requested discharge and died approximately 1 month later. Combined with fever ≥38.5℃, splenomegaly, cytopenia, hypertriglyceridemia, and ferritin ＞1650 ng/mL, the final diagnosis was hemophagocytic lymphohistiocytosis (HLH). This case indicates that Mycobacterium kansasii infection can induce HLH. The coexistence of severe erythema multiforme drug eruption and HLH indicates a critical condition. Clinicians should maintain high suspicion of HLH in patients with prolonged fever, liver injury, cytopenia, and significantly elevated ferritin, and early identification and standardized intervention are essential to improve prognosis.

Key words: Mycobacterium kansasii, severe erythema multiforme drug eruption, hemophagocytic lymphohistiocytosis