临床病例评析——慢性粒细胞白血病合并系统性硬化病

Systemic sclerosis in a patient with chronic myeloid leukemia

目的探讨慢性粒细胞白血病合并皮肤硬化的诊治要点。方法对1例慢性粒细胞白血病患者出现皮肤硬化的临床诊治经过进行分析讨论。结果患者查体提示双手指及掌指关节近端、前臂、颈部、前胸、后背、腹部、双下肢皮肤紧绷，皮肤弹性减退，手指指垫消失，张口受限。骨髓涂片、骨髓活检、骨髓免疫分型及融合基因检测均未见白血病复发证据。皮肤活检：鳞状上皮角化亢进，基底细胞色素增加，真皮血管周围散在淋巴细胞浸润。皮肤硬化证实为SSc，经治疗症状明显减轻。结论SSc可以和慢性粒细胞白血病合并存在，临床上遇到类似患者，应考虑两病合并可能。

Objective To explore the key points of diagnosis and treatment of systemic sclerosis with chronic myeloid leukemia. Methods The diagnosis and treatment of a patient with skin sclerosis were analyzed and discussed. Results Physical examination showed skin tightness existed in the fingers and proximal part to the metacarpophalangeal joint of the hands, forearms, neck, chest, back, abdomen and bilateral lower limbs. Skin elasticity was lost, finger pads disappeared and mouth opening was limited. There was no evidence of leukemia relapse with bone marrow examination. Skin biopsy showed squamous keratinized syndrome, pigments increased in basal cells and lymphocytic infiltrates around perivascular in dermal layer. So the patient was diagnosed as systemic sclerosis. The symptom was relieved after treatment. Conclusion Systemic sclerosis and chronic myeloid leukemia could coexist in one patient. More attention should be paid to this specific situation although the situation is rare.