糖皮质激素联合托法替布治疗以皮疹为首发症状的系统性结节病一例

Glucocorticoids combined with tofacitinib for systemic sarcoidosis with rash as initial symptom:a case report

系统性结节病是一种累及多器官、系统的肉芽肿性疾病。该文报道1例36岁女性患者,躯干多发结节伴双眼不适4个月就诊,入院后完善各种实验室及辅助检查。皮损处组织病理示真皮浅层见多个结节,由胞质丰富、胞体大、胞核圆形或椭圆形组织细胞组成。PET/CT示全身多发淋巴结肿大伴代谢活跃。最终诊断为系统性结节病,予甲泼尼龙、羟氯喹、托法替布治疗4个月后,皮损明显消退,无新发皮损。该例提示对于育龄期系统性结节病患者可以选用Janus激酶抑制剂代替传统用药中有生殖毒性的免疫抑制剂。

Systemic sarcoidosis is a granulomatous disease involving multiple organs and systems.A 36-year-old woman was admitted due to multiple nodules of the trunk for 4 months.Upon admission,laboratory and auxiliary examinations were performed.A biopsy specimen revealed multiple nodules in the superficial dermis,which were composed of cells with abundant cytoplasm,large cell body and round or oval nuclei.PET/CT revealed systemic multiple lymph node enlargement complicated with active metabolism.She was eventually diagnosed with systemic sarcoidosis.After combined treatment of methylprednisolone,hydroxychloroquine and tofacitinib for 4 months,the skin lesions were significantly mitigated and no new skin lesions were found.This case prompts that Janus kinase inhibitors can be used to replace conventional immunosuppressants with reproductive toxicity for systemic sarcoidosis patients of reproductive age.