吗替麦考酚酯成功治疗干燥综合征并发结节病一例

The successful treatment of one case of Sjogren’s syndrome complicated with sarcoidosis by mycophenolate mofetil

45岁女性患者,四肢、腰臀部多发皮下结节3个月。既往干燥综合征病史8年余。皮肤科情况:四肢、腰臀部可触及9处直径0.8~2.0 cm皮下结节,散在分布,部分结节表面淡红色,无压痛。结节组织病理示真皮内可见大小不等的、由上皮样细胞构成的肉芽肿性结节,其内有少量多核巨细胞;部分结节周围可见少量淋巴细胞及中性粒细胞浸润,部分结节间的胶原颗粒样变性。诊断:(1)结节病;(2)干燥综合征。给予吗替麦考酚酯胶囊0.75g口服,维持治疗5个月余,结节无复发。

A 45-year-old female patient presented with subcutaneous nodules in the waist and buttocks for more than 3 months.The patient had been diagnosed as Sjogren’s syndrome for her typical dry mouth and dry eyes by the Nephrology Department of Tongji Hospital 8 years ago.Dermatological examination:9 subcutaneous nodules with the size of 0.8~2.0 cm scattered in waist and hips,some of the lesions with the hue of light red,without tenderness.The histopathological findings of the lesions showed granulomatous nodules of epithelioid cells of different sizes,with some polynuclear giant cells,a few lymphocytes and neutrophils scattered in the periphery of some nodules,between some of the nodules,there was collagen of granular degeneration.The diagnosis of Sjogren’s syndrome complicated with sarcoidosis was confirmed after the exclusion of other infectious diseases by auxiliary examination.Mycophenolate mofetil had been administered with 0.75 g twice a day for 2 and a half months till all the skin lesions subsided,then the dosage was reduced to 0.50 g twice a day for maintenance treatment for 5 months,and the health condition of the patient was stable.