Westers-Attema Annet, van Tubergen A, Plasschaert H, van Marion A M W, Frank J, Poblete-Gutiérrez P
Department of Dermatology, University Hospital Maastricht, University Hospital Maastricht, The Netherlands.
Int J Dermatol. 2008 Nov;47 Suppl 1:3-6. doi: 10.1111/j.1365-4632.2008.03947.x.
A 42-year-old man presented with fever, photosensitivity, headaches, myalgia, hyperhidrosis, muscle weakness, alopecia, nasal crustae, weight loss, painful nails, arthritis, oral ulcers, erythema, discoid cutaneous lesions, and painful subcutaneous nodes. We made a diagnosis of systemic lupus erythematosus (SLE), type II cryoglobulinemia, and nodular vasculitis. In the skin, different types of vasculitis may be observed. Typically, histology shows leukocytoclastic vasculitis of superficial vessels both in SLE and mixed cryoglobulinemia, which clinically results in palpable purpura. In our patient, however, histopathological examination of the subcutaneous nodes not only revealed leukocytoclastic vasculitis of the superficial vasculature but also showed even more extensive involvement of dermal and subdermal small and medium sized vessels, giving rise to a nodular vasculitis.
一名42岁男性患者出现发热、光敏、头痛、肌痛、多汗、肌肉无力、脱发、鼻痂、体重减轻、指甲疼痛、关节炎、口腔溃疡、红斑、盘状皮肤损害以及疼痛性皮下结节。我们诊断为系统性红斑狼疮（SLE）、II型冷球蛋白血症和结节性血管炎。在皮肤方面，可观察到不同类型的血管炎。通常，组织学显示系统性红斑狼疮和混合性冷球蛋白血症中浅表血管的白细胞破碎性血管炎，临床上表现为可触及的紫癜。然而，在我们的患者中，皮下结节的组织病理学检查不仅显示浅表血管系统的白细胞破碎性血管炎，还显示真皮和皮下中小血管有更广泛的受累，从而导致结节性血管炎。
