Gomes Rui M, Cerio Dean R, Loghmanee Cyrus, McKinney Justin, Patel Mili, Miraglia Janeen, Yousef-Bessler Manal, Zippin Jonathan H, Schuetz Audrey N, Pinho Paulo Bandeira
PASE Healthcare, PC, 225 Millburn Avenue, Suite 303, The Common, Millburn, NJ 07041, USA.
East Coast Advanced Plastic Surgery, 79 Hudson Street, Suite 700, Hoboken, NJ 07030, USA.
J Clin Med. 2013 Nov 22;2(4):260-3. doi: 10.3390/jcm2040260.
An 87-year old Caucasian male with past medical history of rheumatoid arthritis (RA) and chronic kidney disease presents with left hand erythema, pain, tenderness, induration and edema. Clinically, these hand findings began proximal to the metacarpo-phalangeal joints and extended to the distal wrist. He was noted to have ipsilateral axillary lymph node enlargement but denied any constitutional signs or symptoms. Laboratory markers of inflammation were poor prognostic indicators due to relatively active RA, the use of chronic daily glucocorticoids and weekly adalimumab use. Oral antibiotics were administered with limited success leading to a skin biopsy which reported a hematogenously disseminated fungal panniculitis; cultures grew Cryptococcus neoformans, however, serum cryptococcal antigen was negative. With initial fluconazole treatment, skin findings and lymphadenopathy improved gradually over the next six months. However, the patient's improvement stagnated and his condition reverted back to the state of initial presentation.
一名87岁的白种男性，有类风湿性关节炎（RA）和慢性肾脏病病史，现出现左手红斑、疼痛、压痛、硬结和水肿。临床上，这些手部表现始于掌指关节近端，并延伸至腕部远端。他被发现同侧腋窝淋巴结肿大，但否认有任何全身症状。由于类风湿关节炎相对活跃、长期每日使用糖皮质激素以及每周使用阿达木单抗，炎症的实验室指标是预后不良的指标。给予口服抗生素治疗效果有限，随后进行了皮肤活检，结果报告为血行播散性真菌性脂膜炎；培养物生长出新型隐球菌，然而，血清隐球菌抗原呈阴性。最初使用氟康唑治疗后，皮肤表现和淋巴结病在接下来的六个月中逐渐改善。然而，患者的病情改善停滞，病情又恢复到最初就诊时的状态。
