发热型溃疡型急性痘疮样苔藓样糠疹合并肝炎和肺真菌感染1例

A Case of Hyperthermic Ulcero-necrotic Pityriasis Lichenoides et Varioliformis Acuta with Hepatitis Infection and Pulmonary Fungal Infection

患者男,34岁,躯干红斑、丘疹半月余,泛发全身10d。皮损为密集分布的大小不一的红斑、丘疹,部分红斑、丘疹上可见米粒大小的水疱及浅溃疡和暗黑色痂,水疱疱液清,壁厚,尼氏征阴性。躯干见散在色素沉着斑,无明显脓疱、糜烂、渗液。皮损组织病理示:表皮角化不全伴少许炎细胞浸润,表皮内和真皮浅层广泛红细胞外渗,表皮细胞内和细胞间水肿伴变性、坏死,部分棘层松解,表皮和真皮浅层界限模糊不清,真皮浅、中层小血管周围致密淋巴细胞、组织细胞浸润。乙肝表面抗原、乙肝e抗原、乙肝核心抗体三项阳性。诊断:发热型溃疡型急性痘疮样苔藓样糠疹。服用强的松1个月后,患者行支气管镜检查刷片示真菌孢子阳性,痰培养示白色念球菌,予氟康唑胶囊治疗2周后症状好转。

A 34-year-old male presented with extensive red papules and erythema on the trunk for a half of month,and bacame generalized for 10 days.Different sizes of erythema,papules,a grain of blisters,ulcerations and black scabs on the whole body.Nikolsky＇s sign was negative.The histopathological showed epidermis parakeratosis,intracelluar edema and neutrophils and red blood cells inliquefaction of basal cells and regional lymphoyteinfiltra-tions.Hepatitis-B surface antigen,Hepatitis-B e antigens,Hepatitis-B core antibody were positive.The diagnosis was hyperthermic ulcero-necrotic pityriasis lichenoides et varioliformis acuta.One month after using prednisone,the test of bronchoscopy brush of the patient showed fungi was positive and culture of the sputum showed growth of candida albicans.After two weeks of treatment of fluconazol,symptoms improved.