以四肢多发活动性结节为主要表现的脂肪膜性脂肪坏死合并皮肤钙沉着症一例

Multiple active nodules of extremities were the main manifestations of lipomembranous fat necrosis complicated with calcinosis cutis:a case report

59岁女性患者,因反复双小腿红斑、结节伴疼痛1年,加重6个月就诊。皮肤科情况:双小腿散在网状及片状紫红斑、毛细血管扩张及色素沉着,四肢可扪及数个黄豆至蚕豆大小皮下结节,质硬、有压痛,活动度可,表面皮肤正常。结节皮损组织病理示表皮萎缩,真皮水肿,皮下脂肪灶性坏死,脂肪膜呈羽毛状突入脂肪膜微囊,皮下脂肪层可见钙质沉积。诊断:脂肪膜性脂肪坏死合并皮肤钙沉着症。予以沙利度胺50 mg每日3次、白芍总苷胶囊0.6 g每日2次口服等治疗。随访6个月后,部分结节消退,疼痛缓解。

The patient is a 59-year-old female presented with repeated erythema and nodules on both legs with pain for one year,which aggravated over the last 6 months.Dermatological examination showed that scattered reticular and patchy erythema,telangiectasia and pigmentation on both legs.Several subcutaneous nodules,ranging from the size of soybeans to broad beans,were palpable on the limbs.These nodules were mobile,hard and tender,with no surface ulcers.The surface skin appeared normal.Histopathological examination of the nodules showed epidermal atrophy,dermal edema,and focal necrosis of subcutaneous fat with calcium salt deposition.The fat membrane exhibited a feathery appearance and protruded into the microcapsules of the fat membrane.No cercariae of parasites were observed.The diagnosis was lipomembranous fat necrosis complicated with calcinosis cutis.After 6 months of treatment with thalidomide(50 mg three times daily)and total glucosides(0.6 g twice daily),some nodules subsided,and the patient experienced relief from pain.