类风湿性嗜中性皮炎一例并文献复习

Rheumatoid neutrophilic dermatitis:a case report and literature review

报道1例类风湿性嗜中性皮炎并复习相关文献。患者,女,60岁。四肢红斑、丘疹、结节痛1年余,加重伴水疱、脓疱1周。患者确诊类风湿关节炎3年余,类风湿因子阳性。三次组织病理示表皮表现不一,真皮浅中层均可见较多弥漫中性粒细胞浸润,可见核尘,并可见少量淋巴细胞浸润,血管内皮肿胀伴红细胞外溢,未见血管炎改变。DIF阴性。诊断:类风湿性嗜中性皮炎。结合病例及相关文献,对此病发病机制、临床及病理、治疗等进行综合分析。

A case of Rheumatoid neutrophilic dermatitis is reported and related literature is reviewed. A 60-year-old woman presented with multiple erythematous plaques and nodules on extremities with pain for more than one year, aggravating for 1 week with vesicles or pustules. She had rheumatoid arthritis with positive rheumatoid factor for 3 years. Three skin biopsies were taken from a blister, plaque and nodule. Histological examination of three times revealed different pathological manifestations of epidermis, dense and diffuse infiltration of mainly neutrophils and rarely lymphocytes in the upper and mid-dermis, with nuclear dust and vascular endothelial swelling, extravasation of erythrocytes were noted, but vasculitis was absent. A direct immunofluorescence revealed no deposits of immunoglobulin or complement. The diagnosis of Rheumatoid neutrophilic dermatitis was made. Based on the case and related literature, the pathogenesis, clinical and pathological features, and treatment of the disease are comprehensively analyzed in this paper.