重症难治性麻风结节性红斑1例死亡病例报告

A Fatal Case Report of Severe Refractory Erythema Nodosum Leprosum

患者男,22岁。四肢反复出现结节性红斑,左肘关节、腕关节疼痛,并伴有发热、乏力6年。8年前在麻风防治机构被确诊为界限类偏瘤型麻风(BL),予联合化疗(MDT)治疗2年。查体:面部散在浸润性红斑,四肢大量疼痛性红色结节,肘、腕关节肿胀压痛;两侧尺神经粗大,无触痛。皮肤组织液涂片抗酸杆菌均(+),细菌指数(BI)4.0。皮损组织病理示:表皮下有"无浸润带",真皮内有巨噬细胞肉芽肿,可见泡沫细胞,抗酸染色阳性。诊断:BL伴Ⅱ型麻风反应。终因治疗无效死亡。尸检提示颅内感染。

A 22-year-old man,with a 6-year history of recurrent multiple painful erythematous nodules over his limbs,pain in the left elbow and wrist,high fever and malaise. 8 years ago,he was diagnosed with borderline lepromatous leprosy（ BL） in the leprosy prevention and control institutions,and received the multidrug therapy（ MDT） for 2 years. Physical examination： the patient had facial infiltrated erythema,touch pain in the left elbow and wrist,multiple painful erythematous nodules over his limbs,and pronounced bilateral nontender ulnar nerve thickening without tenderness Slit-skin smear examinations were positive for acid fast bacilli（ bacterial index 4）. Histologicexamination of the skin showed a clear grenz zone beneath the epidermis separating macrophage granulomata in the dermis from the epidermis. He received the diagnosis of BL with accompanying ENL. The patient eventually died. Postmortem results indicate that he died of intracranial infection.