b****a
发帖数: 352 | 1 我实在受不了了，也顾不上批马甲，希望这里的医生指点我到底何去何从。我这个情况
复杂，我希望讲清楚，谢谢你的耐心。
今年1月底，乳房剧痛 红肿，然后有肿块。很大。等约到医生做超声波就是2月中了，
但是当时肿块已经没有了。
等了1－2个月好像又有肿块，5月突然我觉得摸到很大一个（5cm 多）肿块，做了超声
波，医生 ""quite vascular, hypoechoic colletion, and more suspicious for
infection" STILL 建议biopsy。
biopsy pathology test 结果是 diagnosis is granulomatous mastitis.
granulation tissue with scattered granulomas that display central
neutrophili aggregates
然后医生让我等他自己好。
等到10月份还是没有消，我就要pcp给我看了specialist
她说很concern 让我做MRI ， MRI 显示enhancement 就做了2个地方的biopsy.
pathology 不是cancer. culture test 没有常见细菌和fungus,但是有
propionibacterium acnes
恶梦就此开始。
biopsy（10月中后 整个乳房肿胀疼痛，一个biopsy的伤口久久不能癒合 （现在5个星
期）。伤口开始长好，然后就会爆开，流脓血。反复3－4次。
昨天我觉得伤口上有一层脓痂，刚刚取下纱布，今天乳房胀痛，然后被碰一下后，脓血
喷了好多，打湿衣服。我看到伤口2cm 长，根本就没有长上，能看到里面的组织。我吓
的一直抖。。。
以下是医生的治疗：
10月31好pcp给我开了dicloxacilin 500mg 吃了10天。可能有好转？或者没有？我不
确定
之后继续不好，breast surgeon 帮我处理了伤口，让我看infectious disease 医生
上个星期2第一次看他，给我order 一堆血检
现在血检结果出来一些，我看igG ， wbc， ab neutrophil , c reactive protein
inflammatory 高，lymphocyte%低 ，好像都是chronic infection 指示。还有些测ab
to fungus 结果没回来。
下个星期才见医生，但是他之前说如果血检结果不是常见fungus,他回让surgeon 取一
大块tissue， culture 可能 up to 4 weeks. 之后才能确定是什么感染，然后才开始
治疗。他觉得不是常见细菌，常用抗生素不会有用
但是我真的濒临崩溃。。。。。这么长时间一个伤口，我天天觉得很难受，还让我自己
处理伤口。。。我精神压力很大。
我想请问这个治疗方案对不对？
我一个朋友说你不如回国，国内医生直接上抗生素，马上管用。
我想请问是不是这样？我这样长期感染是不是很不好？现在这个感染还要手术是不是回
更糟糕？
版上医生仁心仁术，请告诉我到底应该怎么半？
谢谢 | m**********r
发帖数: 2099 | | l*h
发帖数: 4124 | 3 直接上抗生素，马上管用: this is hugely untrue. you might have 0 - 3% chance
of being lucky 马上管用.
what your surgeon and ID specialist did was absolutely correct, especially
so because you are from China.
the basic pathology feature is granulomatous changes with inflammatory cell
infiltration. this is caused by special bacteria or fungi. your surgeon knew
this and sent you to the ID specialist. each and every of these is
different and their treatment requires commitment of 6 - 24 months of
medication. medmallawyer is right in that tuberculosis is the most common
among these, e.g., over 90% in people from China.
【在 b****a 的大作中提到】
: 我实在受不了了，也顾不上批马甲，希望这里的医生指点我到底何去何从。我这个情况
: 复杂，我希望讲清楚，谢谢你的耐心。
: 今年1月底，乳房剧痛 红肿，然后有肿块。很大。等约到医生做超声波就是2月中了，
: 但是当时肿块已经没有了。
: 等了1－2个月好像又有肿块，5月突然我觉得摸到很大一个（5cm 多）肿块，做了超声
: 波，医生 ""quite vascular, hypoechoic colletion, and more suspicious for
: infection" STILL 建议biopsy。
: biopsy pathology test 结果是 diagnosis is granulomatous mastitis.
: granulation tissue with scattered granulomas that display central
: neutrophili aggregates
| b****a
发帖数: 352 | 4 非常感谢你详细的解释。 这样我心理放心不少。
关于 tb 医生也是最开始怀疑这个。
10 月biopsy culture test 没有tb
1个星期前医生又做了tb 的血检和x-ray
血检 : inconclusive
chest x-ray: negative
不知道这样是不是算排除了
另一个问题：如果还要开刀取大块组织，那这样伤口不是也不能愈合
我10月份biopsy 这个伤口一直是豁开的，2cm 长， 我已经很害怕了。 一直有个创口
是不是也是危险，容易其他感染呢？
chance
cell
knew
【在 l*h 的大作中提到】
: 直接上抗生素，马上管用: this is hugely untrue. you might have 0 - 3% chance
: of being lucky 马上管用.
: what your surgeon and ID specialist did was absolutely correct, especially
: so because you are from China.
: the basic pathology feature is granulomatous changes with inflammatory cell
: infiltration. this is caused by special bacteria or fungi. your surgeon knew
: this and sent you to the ID specialist. each and every of these is
: different and their treatment requires commitment of 6 - 24 months of
: medication. medmallawyer is right in that tuberculosis is the most common
: among these, e.g., over 90% in people from China.
| l*h
发帖数: 4124 | 5 不知道这样是不是算排除了: I don't think it is considered ruled out by the
tests you mentioned.
P. acnes is part of the normal flora on adult skins. it rarely causes deep
tissue infection in people with normal immune system, and it can be easily
detected by regular culture. one time (+) on culture usually means
contamination of the sampling process. if it is repeatedly seen on culture,
then it is likely in the deep tissue infection.
because the treatment of these types of special infection takes so long, you
really want to positively ID the pathogen before starting treatment.
the ID of special bacteria and fungi is also pretty slow, e.g., mycobacteria
usually take ~3weeks or longer to grow on culture before an ID can be made.
if you had contact with birds, wild animals etc., or visited some places
before getting the disease, tell your ID specialist.
as for the question 容易其他感染呢？: as long as the drainage is good, it is
not a big concern. if you have sudden fever etc., call your ID specialist
immediately.
the secretion can also be cultured for pathogen identification, but it has a
fairly high chance of producing false positive results.
anyway, tell your ID specialist all the relevant information and follow his/
her instructions, also ask him/her questions if you have any. once the
pathogen is identified, things will become much easier.
【在 b****a 的大作中提到】
: 非常感谢你详细的解释。 这样我心理放心不少。
: 关于 tb 医生也是最开始怀疑这个。
: 10 月biopsy culture test 没有tb
: 1个星期前医生又做了tb 的血检和x-ray
: 血检 : inconclusive
: chest x-ray: negative
: 不知道这样是不是算排除了
: 另一个问题：如果还要开刀取大块组织，那这样伤口不是也不能愈合
: 我10月份biopsy 这个伤口一直是豁开的，2cm 长， 我已经很害怕了。 一直有个创口
: 是不是也是危险，容易其他感染呢？
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