以紫癜样皮损为首发表现的系统性红斑狼疮误诊分析

Analysis on Misdiagnosis of Systemic Lupus Erythematosus with Purpura Skin Lesions as the First Manifestation

目的探讨以紫癜样皮损为首发表现的系统性红斑狼疮(SLE)的临床特点及误诊原因,以降低SLE早期误诊率。方法回顾性分析2012年1月至2017年10月年四川省人民医院皮肤科、风湿科诊断明确、临床资料完整的8例以紫癜样皮损为首发表现的SLE患者的临床表现、实验室及免疫学检查。结果 6例紫癜样皮损位于四肢,2例紫癜样皮损位于双下肢,8例在发病初期均缺乏典型的蝶形红斑,8例血小板均正常,6例发生肾脏损害,5例发生血液系统损害,8例免疫系统检查均有异常,均被误诊为过敏性紫癜(HSP),平均误诊时间超过2个月,误诊率为100%。结论以紫癜样皮损为首发表现且缺乏典型蝶形红斑的SLE临床少见,极易误诊为HSP,应提高诊断SLE的警惕性,对于出现紫癜样皮损,同时合并多系统损害的患者应早期行免疫学检查来明确诊断。

Objective To investigate clinical characteristics and cause of misdiagnosis for systemic lupus erythematosus（ SLE） with purpura-like lesions as the first manifestation so as to reduce the early misdiagnosis rate of SLE. Methods This study was conducted on 8 SLE patients with purpura-like lesions as the first manifestation with definite diagnosis and complete clinical information at the Department of Dermatology and Department of Rheumatology of Sichuan Provincial People＇s Hospital,between Jan. 2012 and Oct. 2017. Their clinical manifestations,laboratory and immunological tests were retrospectively analyzed. Results Among them,6 patients had purpura-like lesions on the limbs,including 2 patients with purpura-like lesions on both lower extremities,and all patients lacked typical butterfly erythema in their early stages. Their platelet counts were all normal,but 6 patients had kidney damage,5 patients had blood system damage,and all patients had abnormal immune system tests. The 8 patients were all misdiagnosed as Henoch-Schonlein purpura（ HSP）,and the average misdiagnosis time was over 2 months. The misdiagnosis rate was 100%. Conclusion SLE with purpura-like lesions as the first manifestation and lack of typical butterfly erythema is clinically rare and may easily be misdiagnosed as HSP. Doctors should improve the vigilance of SLE and carry out early immunological examination for these patients with purpura skin lesions and multiple-system damage.