伴有结核血行播散的寻常狼疮1例

Lupus Vulgaris with Hematogenous Spread: A Case Report

患者女,75岁,左侧下颌部、颈部及左侧前胸反复出现囊肿、结痂、瘢痕增生1年,加重并出现咳嗽、咳痰1个月。皮疹及症状逐渐进展,且出现系统症状,患者长期居住在牧区。胸部CT示:双肺分布、大小、形态不均一的片状影,右肺显著,右侧胸腔积液,双侧胸膜增厚;头颅CT示:左侧额叶高密度结节影,左侧筛窦及额窦低密度影;结核菌素试验强阳性。左侧前胸部的皮肤行皮肤活检示:真皮中上部可见较多的上皮样肉芽肿,其间有多核巨细胞。诊断:伴有结核血行播散的寻常狼疮。诊断明确后转院至传染病医院就诊及治疗。

A 75-year-old female recurrently presented with cysts, crust and atrophic scars on left jaw, neck, and chest for almost one year, as aggravated and appeared cough and sputum production for one month.The rash and symptoms developed gradually with systemic symptoms.The patient had lived in pastoral area since childhood.Chest computed tomography(CT) showed uneven distribution, size and shape of patchy shadows in both lungs, prominent right lung, pleural effusion on the right side, and bilateral pleural thickening.Head CT showed high density nodular shadow in left frontal lobe and low density shadow in left ethmoid sinus and frontal sinus.Tuberculin test was strongly positive.Histopathology of the left chest revealed epithelioid granulomas without caseous necrosis containing a few multinucleated giant cells throughout the dermis.Diagnosis: lupus vulgaris with hematogenous spread.After definite diagnosis, he was transferred to infectious disease hospital for treatment.