人工皮炎误诊为坏疽性脓皮病1例

A Case of Dermatitis Artefacta Misdiagnosed as Pyoderma Gangrenosum

患者男,69岁。反复全身红斑丘疹溃疡3年,加重1年余。曾以"坏疽性脓皮病"治疗无效。查体见颜面部散在大小不等褐色斑疹、溃疡,最大溃疡约2cm×1cm大小,无明显触痛,躯干四肢可见散在大小不一的圆形、椭圆形红斑,部分红斑上可见表浅溃疡,部分皮疹已形成凹陷性瘢痕。皮损组织病理:切片中央表真皮浅层坏死结痂,见较多中性粒细胞及核尘,真皮下部及皮下脂肪未见明显炎症细胞浸润。直接免疫荧光(-)。诊断:人工皮炎。予盐酸舍曲林及奥氮平口服,病情明显好转,局部溃疡完全愈合。

A 69-year-old male was hospitalized for recurrent systemic erythematous papule and ulcers for 3 years,which were aggravated for 1 year."Pyoderma gangrenosum"was initially diagnosed,which,however,was treated ineffectively.Skin examination showed brown maculas and ulcers of different sizes that were scattered on the face,with the largest ulcer of approximately 2cm × 1cm in size without tenderness.There were round or oval erythema of various sizes on the trunk and limbs,and a few superficial ulcers on some of the erythema.Some rashes had formed depression scars.Histopathology of the skin lesions revealed necrotic crust in the epidermis and superficial dermis of the central section,many neutrophils,much nuclear dust,and no significant inflammatory cell infiltration in the dermis and subcutaneous fat.The result of direct immunofluores- cence was negative.Accordingly,we diagnosed it as dermatitis artefacta,which was treated with sertraline hydrochloride and olanzapine orally.After treatment,the patient's condition was improved significantly,and local ulcer was completely healed.