坏疽性脓皮病三例诊治分析

Pyoderma gangrenosum:a report of 3 cases

目的加强外科医生对坏疽性脓皮病的认识,避免误诊误治。方法回顾性分析10年来经外科治疗的3例坏疽性脓皮病的临床资料。结果 3例患者均表现为皮肤软组织坏死,形成潜行性疼痛性溃疡,伴发热;均按"感染"治疗,但创面分泌物多次培养阴性;各种抗生素治疗无效,积极清创换药而创面继续扩大,溃疡活检病理为非特异性炎症。诊断为坏疽性脓皮病后经全身糖皮质激素及免疫抑制剂治疗结合创面局部换药,病情均迅速得到控制并逐步缓解。结论坏疽性脓皮病易被误诊。确诊后病情重者应早期使用糖皮质激素和免疫抑制剂系统治疗,病情可迅速得到控制,创面经温和换药可自行愈合。

Objective To improve the surgeon＇s understanding of pyoderma gangrenosum （PG） and avoid misdiagnosis and incorrect treatment. Methods Three cases of PG managed in the department of general surgery during the past 10 years were retrospectively reviewed. Results All of the 3 cases mainly presented with necrosis of skin and soft tissues, followed by formation of painful and extensive creeping ulcer. They all had fever and were initially diagnosed and managed as ＂ infection＂, but repeated wound exudates culture showed negative results and antimicrobial therapy was not effective. The ulcers were enlarged quickly despite of active debridement. Histopathology of ulcer biopsy suggested nonspecific inflarmnation. After the diagnosis of PG was established, systemic therapy with steroids and immunosuppressants were administered together with local wound care. The progress of the disease was controlled soon and fully resolved finally. Conclusions Pyoderma gangrenosum is misdiagnosed frequently. For severe patients, systemic therapy with steroids and immunosuppressants should be used as early as possible and skin lesions would heal together with mild local wound care.