结节性类天疱疮1例

A Case of Pemphigoid Nodularis

患者男,79岁。全身反复红斑、结节、水疱,痒5年,加重1个月。皮肤科情况:头皮、躯干、四肢见黄豆至甲盖大小红斑、结节。结节孤立互不融合,基底浸润,表面粗糙、肥厚,其上可见抓痕、结痂。红斑及结节上散在绿豆至指甲大小水疱,疱壁厚,紧张发亮,尼氏征阴性。皮损组织病理示:表皮角化过度伴角化不全,棘层肥厚,表皮下水疱,真皮浅层见淋巴细胞及嗜酸性粒细胞浸润。直接免疫荧光:皮肤基底膜带Ig G线状沉积。Ig A,Ig M,C3阴性。诊断:结节性类天疱疮。

A 79-year-old male patient presented with recurrent widespread erythema, nodules and blisters with pruritus for 5 years, aggravated 1 month. Dermatology examination showed the erythema and nodules, soybean to nail sized, were on the scalp, trunk and limbs. The nodules were isolated, with infiltrating basement, hypertrophic surface and crusts. The blisters with thick wall, mung bean to nail sized, occurred on the erythema and nodules. Nikosky＇s sign was negative. Histopathology examination showed hyperkeratosis,parakeratosis,acanthosis, subepidermal bulla, the infihration of eosinophils and lymphocytes in the upper dermis. Direct immunofluorescence revealed linear deposition of IgG at the basement membrane zone while IgA, IgM, C3 was negative. Diagnosis of pemphigoid nodularis was made.