PAPASH综合征一例

2018-03-14 佚名 中华皮肤科杂志

患者男,22岁。面颈部、背部、腋窝、腹股沟暗红色丘疹、结节、脓疱、囊肿6年,双下肢多发暗紫红斑块伴溃疡1年,2016年10月31日于郑州大学第一附属医院皮肤科就诊。

【一般资料】

患者男,22岁

【主诉】

面颈部、背部、腋窝、腹股沟暗红色丘疹、结节、脓疱、囊肿6年,双下肢多发暗紫红斑块伴溃疡1年,2016年10月31日于郑州大学第一附属医院皮肤科就诊。

【现病史】

6年前,患者于某院诊断为痤疮,未予治疗。1年前双下肢出现多发紫红色斑块,后破溃并融合成溃疡,直径1~12cm。2002年5月9日,患者因左膝关节肿痛半年就诊于郑州大学第一附属医院小儿内科,检查示类风湿因子阴性,左膝关节腔积液涂片:中性粒细胞、少量淋巴及单核细胞,未见异常细胞,

【初步诊断

诊断为左膝化脓性关节炎。

【体格检查】

囊肿型痤疮和化脓性汗腺炎表现:患者颜面、腰背部炎性丘疹、脓疱、脓肿及囊肿,部分破溃,腋窝及腹股沟化脓性汗腺炎损害一般情况欠佳,行走困难,血压142/92mmHg。双下肢多发紫红色斑块,中央溃疡形成。

【辅助检查】

下肢溃疡边缘皮损组织病理:表皮破溃,细胞间水肿,可见中性粒细胞进入,真皮浅中层明显水肿,局灶红细胞外溢,中性粒细胞、淋巴细胞、组织细胞为主弥漫性浸润,临床及病理符合坏疽性脓皮病。面颈部、腰背部可见广泛炎性丘疹、脓疱、脓肿及囊肿,腋窝、腹股沟少量暗红色结节,呈囊肿痤疮及化脓性汗腺炎表现。基因检测:PSTPIP1基因测序:外显子区未见突变,内含子区发现c.36+68G>A、c.137+47G>C、c.562+114C>Ghet复合杂合突变,在100例正常人测序中有45例发现该位点突变,考虑为多态性位点,致病意义不能明确。最终诊断:PAPASH综合征。

【治疗】

给予甲泼尼龙、头孢米诺、异维A酸及沙利度胺治疗,2周后皮损明显好转。现患者仍在随访中。

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    2018-03-17 虈亣靌

    学习谢谢分享!

    0

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    2018-03-16 kksonne
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