摘要
患者男,48岁,全身皮疹10余年,四肢水肿9个月。患者10余年前躯干、四肢出现皮疹,9个月前诊断为瘤型麻风,予多菌型联合方案治疗;治疗后全身皮疹消退,但四肢远端逐渐出现水肿、皮肤增厚、变硬,6个月前双足部出现乳头瘤样皮疹,4个月前右手指背侧出现水疱、破溃、脓性分泌物。患者左足背部及右上肢皮损组织病理示:角化过度,灶性角化不全,颗粒层增生,棘层不规则增厚,轻度细胞间水肿;真皮层成纤维细胞弥漫性浸润,胶原纤维增生、增粗、红染;真皮层毛细血管增生、扩张,血管周围轻度淋巴细胞、组织细胞浸润。抗酸染色:4+~5+,颗粒菌。过碘酸雪夫染色:阴性。双侧眉弓、耳垂组织液抗酸染色:左侧眶上、右侧眶上、左耳垂、右耳垂均4+,BI值4.0。诊断:①瘤型麻风;②淋巴水肿性角皮症。
A 48-year-old male patient presented with rashes on his trunk and limbs for over 10 years and edema in his extremities for 9 months.Nine months ago,he was diagnosed with lepromatous leprosy and treated with a multibacillary combined regimen.Following treatment,the rash subsided throughout his body,but edema gradually appeared at the distal extremities,accompanied by skin thickening and hardening.Six months ago,papillomatous rashes developed on both feet.And 4 months ago,blisters,ulcerations,and purulent discharge occurred on the dorsal side of the right hand.Skin tissue biopsy from the left foot′s dorsal part and the right upper limb revealed hyperkeratosis,focal parakeratosis,granular layer hyperplasia,irregular thickening of the spinous layer,and mild intercellular edema.There was diffuse infiltration of dermal fibroblasts,with hyperplasia,thickening,and red staining of collagen fibers.Dermal capillaries showed hyperplasia and dilation,with mild lymphocyte and histiocyte infiltration around the vessels.Acid-fast staining was positive(4+to 5+),indicating granular bacilli.Periodic acid-Schiff(PAS)staining was negative.Acid-fast staining of tissue fluid from the bilateral supraorbital arches and earlobes showed positive results(4+on both left and right supraorbital arches,and 4+on both left and right earlobes),with a bacteriological index(BI)value of 4.0.The diagnosis was lepromatous leprosy and lymphedema keratoderma.
作者
甘丽平
罗红叶
黄天福
沈廷梅
张春雨
GAN Liping;LUO Hongye;HUANG Tianfu;SHEN Tingmei;ZHANG Chunyu(Department of Dermatology,Yunnan Province Wenshan Prefecture Dermatology Prevention and Treatment Institute,Wenshan Prefecture Dermatology Specialist Hospital,Wenshan 663000,China)
出处
《中国皮肤性病学杂志》
北大核心
2025年第9期1040-1043,共4页
The Chinese Journal of Dermatovenereology
基金
文山州科技计划项目-文山州李玉叶专家工作站(2023-04)。
关键词
淋巴水肿性角皮症
瘤型麻风
Lymphedema keratoderma
Lepromatous leprosy
