类风湿性嗜中性皮炎1例

Rheumatoid neutrophilic dermatitis:a case report

患者女,52岁。四肢红斑、丘疹伴瘙痒6个月,加重有水疱1周。皮肤科情况:躯干、臀部、四肢可见边界清楚的环状水肿性红斑,红斑边缘可见米粒至黄豆大小厚壁水疱,水疱排列呈环状,红斑中央可见坏死、糜烂面,渗出不明显,部分红斑中央可见褐色痂皮附着,部分痂皮脱落遗留领圈状脱屑。右侧髋部皮损组织病理检查示表皮角化过度,棘层增生肥厚,真皮浅中部胶原束间、血管周围、附属器周围可见大量中性粒细胞及中性粒细胞尘核浸润,未见血管纤维蛋白样变。诊断:类风湿性嗜中性皮炎。治疗:给予甲泼尼龙40 mg每日1次口服,同时给予护胃、补钾、补钙等对症治疗,卤米松乳膏及夫西地酸钠乳膏外用。

A 52-year-old female patient presented with erythema,papules and pruritus on extremities for six months,with blisters for one week.Dermatologic examination showed ring-shaped edematous erythema lesions with clear boundaries on the trunk,buttocks,and limbs.Along the edges of the erythematous areas,there were thick-walled blisters ranging in size from rice grains to soybeans,arranged in a ring formation.The center of the erythema showed necrotic erosions with a brown scab,some of which are adherent and some detached.There was no significant exudation noted.Histopathological examination of the skin rash of the right hip revealed excessive keratosis in the epidermis,hyperplasia and hypertrophy of the spinous layer,and a significant presence of neutrophils observed between collagen bundles in the superficial dermis,around blood vessels,and appendages.No vascular fibrinoid changes were observed.The patients was diagnosed as rheumatoid neutrophilic dermatitis.Treatment included methylprednisolone 40 mg once daily,along with symptomatic care including gastroprotective measures,and supplementation with potassium and calcium.External treatment involved halomethasone cream and sodium fusidate cream.