肾移植患者麻风伴Ⅱ型麻风反应1例并文献复习

Leprosy with Type Ⅱ Lepra Reaction in a Renal Transplant Recipient: A Case Report and Literature Review

患者女,39岁,双下肢疼痛性红斑5月,加重1周。2007年行肾移植手术,术后接受免疫抑制剂治疗。体检:慢性病容,面色稍苍白,面部、胸背部、双上肢可见弧形分布的暗红色斑片,中央见色素沉着,边缘可见细碎鳞屑附着,部分指(趾)甲板增厚变形;双小腿、足背可见对称分布的类圆形水肿性红斑,部分融合成片、表面可见坏死及暗褐色痂皮,压痛明显;冷热觉及触觉未见明显异常,浅表神经未触及粗大。组织病理(下肢皮损):真皮巨噬细胞肉芽肿,大量巨噬细胞、泡沫细胞、梭形细胞及少量淋巴细胞、嗜中性白细胞浸润,皮肤附件消失,抗酸染色:6+(杆状)。根据临床表现及相关辅助检查,诊断:1.多菌型麻风伴Ⅱ型麻风反应,2.肾移植术后,3.体癣。

A 39yearold female presented with painful erythema on both lower extremities for 5 months and exacerbated for 1 week. She received renal transplantation in the year 2007 and was then placed on an immunosuppressive regimen. Physical examination showed chronic facies and a little pale coloring; dark red erythema with central pigmentation and scaled edges distributed on the face, chest and upper limbs ; some of the fingernails and toenails became thick and deformed; symmetric, circular, edematous erythema with necrotic darkbrown crusts on the surface and ten derness on the lower limbs and acrotarsium; hot, cold and touch feeling showed no obvious abnor malities. Neurological examination was normal. Histopathology revealed granulomas with a large number of macrophages, foam cells, spindle cells and a small number of lymphocytes and neutro phils in the dermis, skin appendages disappeared and the,acidfast stain demonstrated a bacterio logic index of 6 ＋ （rhabditiform）. According to the clinical manifestations and auxiliary examina tions, the diagnosis of leprosy with type 11 lepra reaction, postrenal transplantation and tinea cor poris was made.