大疱性疥疮

A case of bullous scabies

报告1例大疱性疥疮。患者男,65岁。3个月前无明显诱因躯干、四肢出现散在红斑、水疱、糜烂、结痂,伴瘙痒。患者1个月前指缝间、阴囊处出现类似红斑、丘疹,瘙痒明显。皮肤科检查:躯干、四肢可见弥漫性红斑,部分红斑上可见紧张性水疱,疱壁紧张,疱液清亮,部分水疱破裂后糜烂,可见红色糜烂面,部分表面结痂;双手指缝间、阴囊散在红斑,苔藓样变,可见抓痕。皮损组织病理检查:(左股内侧皮损)角化不全,浆液渗出,可见表皮下疱,疱内可见浆液,大量嗜酸性粒细胞及红细胞,真皮浅层可见嗜酸性粒细胞及中性粒细胞浸润;直接免疫荧光:皮肤全层未见特异性荧光,间接免疫荧光:真皮与表皮交界处(-);镜检发现疥螨。诊断:大疱性疥疮。

A 65-year-old male presented with pruritic scattered blisters and erythemas on the trunk and limbs for 3 months without any apparent cause. Erythemas and papules with intense pruritus appeared on the interdigital areas and scrotum a month ago. Physical examination showed erythemas distributed over the trunk and limbs, tense bullae were seen on some ery- themas, and filled with clear fluid. Parts of the bullae were eroded after rupture, and crusted. Scattered erythemas, liehenification and scratch marks were seen over the fingers and scrotum. Histopathological examination revealed parakeratosis, exudation of serofluid, a large number of eosinophils and red blood cells in the subepidermal bullae, and infiltration of neutrophils and eosinophils in the upper dermis. Direct immunofluorescenee showed no specific fluorescence in all layers of the skin. Indirect immunofluoreseence of epidermal-dermal junetion was negative. Microscopic examination revealed sarcoptic mite. The diagnosis of bullous scabies was made.