同时具有特应性皮炎样及肥厚性扁平苔藓样皮损的慢性移植物抗宿主病

A case report of chronic graft-versus-host disease manifested as both atopic dermatitis-like and hypertrophic lichen planus-like lesions

报告1例同时具有特应性皮炎(AD)样及肥厚性扁平苔藓样皮损的慢性移植物抗宿主病(cGVHD)。患者男,22岁。因全身扁平丘疹伴皮肤干燥、瘙痒4个月就诊。2014年4月患者因急性淋巴细胞白血病行父供子人类白细胞抗原(HLA)7/10相合异基因造血干细胞移植术。皮肤科检查:全身皮肤干燥,毛发稀疏,面部色素沉着,躯干及四肢皮肤毛周隆起,散在紫红色肥厚性丘疹,口腔黏膜损害,甲板纵嵴。皮损组织病理检查:(背部结节)表皮角化亢进,角质层可见少量炎性细胞浸润,颗粒层及棘层不规则增厚,部分区域表皮突杵状下延,部分区域基底层液化变性;真皮浅层带状淋巴细胞浸润,可见噬黑素细胞,真皮小血管增生,内皮细胞肿胀。直接免疫荧光(-)。诊断:同时具有AD样及肥厚性扁平苔藓样皮损的cGVHD。

A case of chronic graft-versus-host disease（cGVHD） appeared as atopic dermatitis（AD） and hypertrophic lichen planus. A 22-year-old male presented with generalized papules with the skin dryness and pruritus for 4 months. Because of acute lymphoblastic leukemia, patient received transplantation of HLAT/10-matched allogeneic hematopoietic stem cells from his father in April 2014. Physical examination showed dry skin all over the body, sparse hair, facial hyperpigmentation, perifollicular eleva- tion on the trunk and limbs, scattered purple hypertrophic papules, oral mucosal damage and longitudinal ridge of the nails. Histopathological examination revealed epidermal hyperkeratosis, a mild inflammatory cell infiltration in the stratum corneum, ir- regularly thickened granular and spinous layers. Some areas exhibited foot-clubbing-like downward extension of epithelia and liquefactive degeneration of the basal layer. Other histological changes included lymphocytic infiltration in the superficial dermis, melanophages and hyperproliferation of small blood vessels in the dermis, and swollen endothelial cells. Direct immunofluorescence showed negative. The diagnosis was cGVHD manifested as both AD-like and hypertrophic lichen planus-like lesions.