2例无菌性脓疱性皮肤病患者的案例分析

Analysis of Two Cases of Patients With Aseptic Pustular Dermatosis

本研究包含2例患者,病例1,男,23岁,全身起疹瘙痒、疼痛5 d,伴发热2 d。查体:全身皮肤潮红、水肿,红斑上见疏密不一绿豆、粟粒大小脓疱,部分脓疱互融成脓湖,尼氏征可疑。组织病理:棘层上见多发性海绵脓疱形成,棘层松解形成水疱,疱内见大量中性粒细胞,真皮浅层水肿。诊断:急性泛发性发疹性脓疱病。病例2,女,24岁,妊娠8个月,全身反复脓疱、瘙痒3个月。查体:耳后、颈、腰、腹、四肢见大小不等圆形,不规则红斑,其上及边周见密集粟粒、针头大小黄白色脓疱,部分融合成脓湖,中央脓疱破溃、结黄褐色痂。病理示:角层下水疱,疱内见大量嗜中性粒细胞,棘层肥厚、棘细胞内及细胞间海绵水肿,基底层灶状液化变性,真皮浅层嗜中性粒细胞、淋巴细胞浸润。诊断:疱疹样脓疱病。

Example 1：A 23-year-old man presented with a 5-day history of rash and pruritus all over his body with fever for 2 days. For lfushing of skin and edema all over the body. Different density of the mungbean-size pustules appeared on the spiloplaxia. Part of the pustules melted into each other to become pustular lfakes. Nikolsky sign was considered. The pathological examination： Multiple cavernous pustules formed on the stratum spinosum, which relaxed to become vesicles. See a lot of neutrophils within the blister. The superifcial dermis became edema. It was diagnosed as acute generalized eruptive pustules. Example 2：A 24-year-old woman（in pregnancy of 8 months） presented with repeatedly pustules and a 3-month history of pruritus. Physical examination：Round irregular erythema spread on the neck, waist, stomach, limbs and behind the ears and were intensive yellow or white pustules with a pinhead size. Part of them melted to become pustular lfakes. The center of pustules burst and began to crust yellow. The pathology showed that a lot of neutrophils appeared within the subcorneal vesicle. There is acanthosis with cavernous edema in and between prickle cells. Focal in basal layer liqueifed and anaplastied. Neutrophils appeared in dermis of skin with lymphocytes inifltrated. It was diagnosed as impetigo herpetiformis.