合并结节型红斑的Sweet综合征1例

Sweet Syndrome Concurrent with Erythema Nodosum:A Case Report

患者男,55岁,手背及面颈部无症状性皮疹、双下肢痛性皮疹3周。皮肤科情况:左侧额部近发际线处、左下眼睑、右侧项部可见数个形状不规则、境界清楚、孤立散在的红色浸润性斑块,无触痛。双下肢对称分布数个近圆形暗红色皮下结节,皮疹光亮紧绷,触痛明显,VAS疼痛评分5分,局部皮温升高。右项部皮肤组织病理示:真皮水肿,全层较多中性粒细胞浸润及灶片状弥漫分布的组织样细胞、淋巴细胞。免疫组织化学染色示:MPO(+)、CD68(+)、CD163(+)。左下肢皮损组织病理示:皮下脂肪小叶间隔增宽伴纤维素样变性,其内见散在少量淋巴组织细胞浸润,其旁脂肪小叶内血管断面增多。临床诊断为Sweet综合征合并双下肢结节性红斑。

A 55-year-old male presented with asymptomatic rashes on the dorsum of his hands and the face and neck region,along with painful rashes on both lower extremities for three weeks.Dermatological examination revealed several irregularly shaped,well-demarcated,isolated and scattered red infiltrating plaque on the left frontal near the hairline,the left lower eyelid,and the right side of the neck,without tenderness.There were several subcircular dark red subcutaneous nodules distributed bilaterally and symmetrically on both lower legs,exhibiting a shiny and taut appearance,obvious tenderness,a VAS pain score of 5,and locally elevated skin temperature.The histopathology of the skin of the right neck showed:dermal edema,more neutrophilic infiltration in the whole layer,and focally and diffusely distributed histiocytes and lymphocytes.Immunohistochemical staining revealed MPO(+),CD68(+),CD163(+).The histopathology of the skin of the left lower limb revealed widened septa of subcutaneous adipose lobules with fibrinoid degeneration,interspersed with scattered infiltration of a few lymphoid cells,and an increased number of vascular cross-sections within adjacent adipose lobules.The clinical diagnosis was Sweet′s syndrome combined with erythema nodosum of both lower extremities.