回顾分析1例边缘区B细胞淋巴瘤(marginal zone B-cell lymphoma,MZBL)患者接受苯达莫司汀联合利妥昔单抗(bendamustine and rituximab,BR)治疗后继发结节性红斑(erythema nodosum,EN)的临床资料,并结合文献总结EN的临床表现、病理特点...回顾分析1例边缘区B细胞淋巴瘤(marginal zone B-cell lymphoma,MZBL)患者接受苯达莫司汀联合利妥昔单抗(bendamustine and rituximab,BR)治疗后继发结节性红斑(erythema nodosum,EN)的临床资料,并结合文献总结EN的临床表现、病理特点、可能的病因和治疗方法。该患者61岁,女,经骨髓活检、淋巴结活检等诊断为MZBL,予BR方案治疗后出现皮肤改变,且伴有发热、咽痛、关节肌肉疼痛等症状,白细胞介素-6(interleukin 6,IL-6)明显增高,经皮肤活检确诊为EN,未发现感染证据,原发病部分缓解,EN与化学治疗药物相关,经甲泼尼龙等抗炎治疗后迅速控制,后未再出现此类不良反应。淋巴瘤患者治疗后出现皮肤红斑表现,需结合临床表现、皮肤活检,尽早识别病因进行治疗,并对患者进行长期随访。展开更多
A 53-year-old Greek housewife was admitted to hospital because of painful erythematous lesions on the lower (Fig. 1) and upper (Fig. 2) extremities in association with painful ocular hyperemia. These symptoms were pre...A 53-year-old Greek housewife was admitted to hospital because of painful erythematous lesions on the lower (Fig. 1) and upper (Fig. 2) extremities in association with painful ocular hyperemia. These symptoms were preceded by an upper respiratory infection with persistent high-grade fever for about 1 week. Erythematous lesions had appeared 3 days previous to admission. Her medical history included two previous episodes of erythema nodosum (unknown etiology), essential hypertension treated with perindopril 4 mg/day, diabetes mellitus type II under diet only, and multinodular goiter under treatment with thyroxine 0.1 mg/day. Examination of the skin revealed tender, violet-red, subcutaneous erythematous nodules, measuring 2- 3 cm in diameter, located on the anterior and posterior surfaces of the legs (Fig. 1), and tender, violaceous papulo-vesicular lesions located on the face and forearms (Fig. 2). Ocular examination revealed diffuse anterior scleritis. Laboratory tests gave the following values: white blood cell count, 12,600cells/mm3 (neutrophils 78% , lymphocytes 16% , and monocytes 4% ); erythrocyte sedimentation rate (ESR), 109 mm/h; C-reactive protein (CRP), 13 mg/dL (normal range: 0.08- 0.8 mg/dL); normal biochemical parameters and urinalysis. An electrocardiogram, chest X-ray, gastroscopy, colonoscopy and abdominal ultrasound scan were within normal limits. The antistreptolysin (ASTO) level and thyroid function tests gave results within the normal range. A tuberculin skin test, and immunological and serologicall tests, such as tests for viruses, were negative. Histological examination of a biopsy specimen obtained from an erythematous nodule on the left leg showed panniculitis involving inflammation of the septa in the subcutaneous fat tissue without signs of vasculitis. Histopathology of a biopsy specimen obtained from a lesion on the right forearm revealed remarkable inflammatory neutrophilic (predominantly) infiltration throughout the entire dermis admixed with some mononuclear cells (lymphocytes and histiocytes) and sparse eosinophils. Endothelial cells of small vessels showed swelling, without signs of vasculitis. Papillary dermis was edematous (Fig. 3a and b). The patient was treated with prednisolone (initial dose 0.5 mg/kg for 1 week), reduced gradually and suspended after 4 weeks. Five days after the initiation of treatment, the skin lesions vanished and ocular manifestations improved. Leukocyte and neutrophil counts, ESR and CRPreturned to normal on suspension of therapy. There was no recurrence at follow-up 6 months and 1 year later.展开更多
目的:探讨结节性红斑(Erythema nodosum,EN)复发的有关因素。方法:将2016年1月—2022年6月在赣南医科大学第一附属医院诊断为EN的患者分为复发组(26例)和未复发组(59例),对其临床资料进行回顾性对比分析。采用χ^(2)检验及t检验比较2组...目的:探讨结节性红斑(Erythema nodosum,EN)复发的有关因素。方法:将2016年1月—2022年6月在赣南医科大学第一附属医院诊断为EN的患者分为复发组(26例)和未复发组(59例),对其临床资料进行回顾性对比分析。采用χ^(2)检验及t检验比较2组临床特征及实验室检验指标,并对其进行多因素Logistic回归分析;比较EN患者结核菌素纯蛋白衍生物(Purified protein derivative of tuberculin,PPD)试验与结核感染T细胞斑点试验(T cell spot test of tuberculosis infection,T-SPOT.TB)的结果。结果:EN的复发与发病部位(χ^(2)=8.137,P=0.004)、C反应蛋白(χ^(2)=5.412,P=0.020)、中性粒细胞数目(χ^(2)=8.485,P=0.014)有关;多因素Logistic回归分析显示,发病部位(OR=5.394,95%CI=1.744~16.689)、C反应蛋白偏高(OR=3.383,95%CI=1.006~11.375)为EN复发的独立危险因素(P<0.05);T-SPOT.TB结果阳性时抗结核治疗的复发率(10%)比PPD试验结果阳性的复发率(81.4%)低(P<0.05)。结论:EN的复发与发病部位、C反应蛋白、中性粒细胞数目有关;影响EN复发的独立危险因素为发病部位、C反应蛋白;T-SPOT.TB与PPD试验联合应用有助于发现EN患者的结核感染,2项结果阳性时抗结核治疗的EN复发率较低。展开更多
文摘回顾分析1例边缘区B细胞淋巴瘤(marginal zone B-cell lymphoma,MZBL)患者接受苯达莫司汀联合利妥昔单抗(bendamustine and rituximab,BR)治疗后继发结节性红斑(erythema nodosum,EN)的临床资料,并结合文献总结EN的临床表现、病理特点、可能的病因和治疗方法。该患者61岁,女,经骨髓活检、淋巴结活检等诊断为MZBL,予BR方案治疗后出现皮肤改变,且伴有发热、咽痛、关节肌肉疼痛等症状,白细胞介素-6(interleukin 6,IL-6)明显增高,经皮肤活检确诊为EN,未发现感染证据,原发病部分缓解,EN与化学治疗药物相关,经甲泼尼龙等抗炎治疗后迅速控制,后未再出现此类不良反应。淋巴瘤患者治疗后出现皮肤红斑表现,需结合临床表现、皮肤活检,尽早识别病因进行治疗,并对患者进行长期随访。
文摘A 53-year-old Greek housewife was admitted to hospital because of painful erythematous lesions on the lower (Fig. 1) and upper (Fig. 2) extremities in association with painful ocular hyperemia. These symptoms were preceded by an upper respiratory infection with persistent high-grade fever for about 1 week. Erythematous lesions had appeared 3 days previous to admission. Her medical history included two previous episodes of erythema nodosum (unknown etiology), essential hypertension treated with perindopril 4 mg/day, diabetes mellitus type II under diet only, and multinodular goiter under treatment with thyroxine 0.1 mg/day. Examination of the skin revealed tender, violet-red, subcutaneous erythematous nodules, measuring 2- 3 cm in diameter, located on the anterior and posterior surfaces of the legs (Fig. 1), and tender, violaceous papulo-vesicular lesions located on the face and forearms (Fig. 2). Ocular examination revealed diffuse anterior scleritis. Laboratory tests gave the following values: white blood cell count, 12,600cells/mm3 (neutrophils 78% , lymphocytes 16% , and monocytes 4% ); erythrocyte sedimentation rate (ESR), 109 mm/h; C-reactive protein (CRP), 13 mg/dL (normal range: 0.08- 0.8 mg/dL); normal biochemical parameters and urinalysis. An electrocardiogram, chest X-ray, gastroscopy, colonoscopy and abdominal ultrasound scan were within normal limits. The antistreptolysin (ASTO) level and thyroid function tests gave results within the normal range. A tuberculin skin test, and immunological and serologicall tests, such as tests for viruses, were negative. Histological examination of a biopsy specimen obtained from an erythematous nodule on the left leg showed panniculitis involving inflammation of the septa in the subcutaneous fat tissue without signs of vasculitis. Histopathology of a biopsy specimen obtained from a lesion on the right forearm revealed remarkable inflammatory neutrophilic (predominantly) infiltration throughout the entire dermis admixed with some mononuclear cells (lymphocytes and histiocytes) and sparse eosinophils. Endothelial cells of small vessels showed swelling, without signs of vasculitis. Papillary dermis was edematous (Fig. 3a and b). The patient was treated with prednisolone (initial dose 0.5 mg/kg for 1 week), reduced gradually and suspended after 4 weeks. Five days after the initiation of treatment, the skin lesions vanished and ocular manifestations improved. Leukocyte and neutrophil counts, ESR and CRPreturned to normal on suspension of therapy. There was no recurrence at follow-up 6 months and 1 year later.
文摘目的:探讨结节性红斑(Erythema nodosum,EN)复发的有关因素。方法:将2016年1月—2022年6月在赣南医科大学第一附属医院诊断为EN的患者分为复发组(26例)和未复发组(59例),对其临床资料进行回顾性对比分析。采用χ^(2)检验及t检验比较2组临床特征及实验室检验指标,并对其进行多因素Logistic回归分析;比较EN患者结核菌素纯蛋白衍生物(Purified protein derivative of tuberculin,PPD)试验与结核感染T细胞斑点试验(T cell spot test of tuberculosis infection,T-SPOT.TB)的结果。结果:EN的复发与发病部位(χ^(2)=8.137,P=0.004)、C反应蛋白(χ^(2)=5.412,P=0.020)、中性粒细胞数目(χ^(2)=8.485,P=0.014)有关;多因素Logistic回归分析显示,发病部位(OR=5.394,95%CI=1.744~16.689)、C反应蛋白偏高(OR=3.383,95%CI=1.006~11.375)为EN复发的独立危险因素(P<0.05);T-SPOT.TB结果阳性时抗结核治疗的复发率(10%)比PPD试验结果阳性的复发率(81.4%)低(P<0.05)。结论:EN的复发与发病部位、C反应蛋白、中性粒细胞数目有关;影响EN复发的独立危险因素为发病部位、C反应蛋白;T-SPOT.TB与PPD试验联合应用有助于发现EN患者的结核感染,2项结果阳性时抗结核治疗的EN复发率较低。
