Chu Melinda B, Dhandha Maulik, Guo Aibing
Department of Dermatology, St. Louis University, St. Louis, Missouri, USA.
BMJ Case Rep. 2013 Dec 4;2013:bcr2013200998. doi: 10.1136/bcr-2013-200998.
A 60-year-old African-American male patient with a history of seizures, developmental delay, long history of behavioural issues with psychotic episodes, heart, liver, thyroid and kidney diseases presented for evaluation of a right neck skin lesion. Physical examination revealed a shiny purplish-red plaque on the right neck and a thin pink plaque on the posterior neck. The lesions were similar in appearance, but different enough to warrant skin biopsy of each. Pathology demonstrated mycosis fungoides (MF) on the right neck and dermatofibrosarcoma protuberans (DFSP) on the posterior neck. The identification of two rare conditions made us reconsider our diagnosis. After further review, the right neck skin lesion was thought to be anticonvulsant-induced cutaneous lymphoid hyperplasia, not MF. This case demonstrates how insufficient skin biopsy can have significant clinical consequences. Biopsy of the right neck only would have overlooked a DFSP and incorrectly given the patient a diagnosis of MF.
一名60岁的非裔美国男性患者，有癫痫发作史、发育迟缓、长期存在伴有精神病性发作的行为问题，还有心脏、肝脏、甲状腺和肾脏疾病，前来评估右颈部皮肤病变。体格检查发现右颈部有一个光亮的紫红色斑块，后颈部有一个薄的粉红色斑块。这些病变外观相似，但又有足够差异，因此需要对每个病变进行皮肤活检。病理检查显示右颈部为蕈样肉芽肿（MF），后颈部为隆突性皮肤纤维肉瘤（DFSP）。这两种罕见病症的确诊促使我们重新审视诊断。进一步检查后，认为右颈部皮肤病变是抗惊厥药引起的皮肤淋巴细胞增生，而非MF。该病例表明，皮肤活检不充分可能会产生重大临床后果。仅对右颈部进行活检会漏诊DFSP，并错误地将患者诊断为MF。
