阿达木单抗治疗溃疡型合并增殖型坏疽性脓皮病1例

Ulcerative and Vegetative Pyoderma Gangrenosum Successfully Treated with Adalimumab:A Case Report

患者男,59岁,右侧头面部脓肿、溃疡4个月,延及四肢2个月。皮肤科情况:右面部可见掌心大小淡红色斑,其上见不规则疣状增生,伴结痂少许,界限清楚;双手背及部分手指伸侧可见皮肤增厚,表面见疣状增生,有轻度水肿,有少许糜烂、结痂,界限清楚;右小腿外侧及屈侧可见多处红色斑块,融合成片,上有多发不规则深在性溃疡,边缘不整,伴脓性及血性分泌物;左小腿内侧可见一处5 cm×5 cm大小暗红色斑块。结合病史、临床表现以及组织病理,诊断符合坏疽性脓皮病。患者经阿达木单抗治疗后症状改善,面部疣状增生逐渐变平,双小腿溃疡深度逐渐变浅。现已随访10个月,未见坏疽性脓皮病复发。

A 59-year-old male presented with a bscess and ulcer on the right side of the head and face for 4 months,extending to the extremities for 2 months.Dermatological examination showed that palm-sized light red spot on the right face with irregular warty growths,a few crusts,and clear boundaries.A thickened skin with warty growths and mild edema on the back of both hands and some fingers,with a few erosions and crusts,and clear boundaries.Multiple red patches on the lateral and flexural side of the right calf,fused into patches with multiple irregular deep ulcers with irregular edges,with purulent and bloody secretions.On the medial side of the left calf,a dark red patch 5 cm×5 cm in size was seen.Combining history,clinical manifestations and histopathology,the diagnosis of pyoderma gangrenosum was made.The patient′s symptoms improved after adalimumab treatment,the facial warty growths gradually flattened,and the depth of the ulcers on both lower legs gradually became shallower.The skin lesions did not recur after 10 months of follow-up.