Branagan N M, Higgins S P, Halim S A, Le T H
Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
Clin Exp Dermatol. 2009 Jul;34(5):e127-9. doi: 10.1111/j.1365-2230.2008.03152.x. Epub 2009 Apr 27.
A 48-year-old patient presented with a nonhealing leg ulcer and a raised white blood cell count. He was diagnosed with pyoderma gangrenosum (PG) and small lymphocytic leukaemia/chronic lymphocytic leukaemia (SLL/CLL). Eight months later, after undergoing treatment with chlorambucil for the SLL/CLL, and prednisone, ciclosporin and intravenous immunoglobulin for the PG, the patient developed livedo reticularis and palpable purpura, and was diagnosed with systemic polyarteritis nodosa (PAN). The case highlights the difficulty in establishing a diagnosis of PAN by biopsy of cutaneous ulcers alone, and that a diagnosis of PG should raise suspicion of another aetiology.
一名48岁患者出现腿部溃疡不愈合且白细胞计数升高。他被诊断为坏疽性脓皮病（PG）和小淋巴细胞白血病/慢性淋巴细胞白血病（SLL/CLL）。八个月后，在接受苯丁酸氮芥治疗SLL/CLL以及泼尼松、环孢素和静脉注射免疫球蛋白治疗PG后，患者出现网状青斑和可触及的紫癜，并被诊断为结节性多动脉炎（PAN）。该病例凸显了仅通过皮肤溃疡活检来确诊PAN的困难，以及PG的诊断应引发对其他病因的怀疑。
