Department of Dermato-Physiology, Apollonia University, Iasi, Romania; Department of Dermatology, Nicolina Medical Center, Iasi, Romania; P. Poni Research Institute of Macromolecular Chemistry, Romanian Academy of Science, Iasi, Romania.
First Medical Department, University of Medicine and Pharmacy Gr. T. Popa, Iasi, Romania.
Can J Diabetes. 2017 Apr;41(2):129-131. doi: 10.1016/j.jcjd.2016.10.005. Epub 2016 Dec 21.
Bullosis diabeticorum (BD), or diabetic bulla, is 1 of the cutaneous manifestations of diabetes mellitus, reported in 0.5% of people with diabeties in the United States, mostly in adult men who have had long-lasting and uncontrolled diabetes associated with diabetic peripheral neuropathy. However, BD in young children is a mostly unrecognized entity. We present a case of BD in a 3-year-old girl with type 1 diabetes mellitus who had been treated with insulin for 7 months prior to hospitalization. Dermatologic examination revealed a large, tense bulla filled with clear fluid and not associated with pain or pruritus, localized on the lateral margin of the right hand. A 4 mm punch biopsy was taken from the peripheral edge of the bulla under local anesthesia, and histology showed subepidermal bulla and sparse nonspecific infiltrate in the dermis; direct immunofluorescence was negative to complements C3, IgM, IgG and IgA. The particularities of the present case include the bulla in the absence of local trauma or any other complications of diabetes and associated with well-controlled type 1 diabetes. The diagnosis was certified by histology, direct immunofluorescence and clinical outcome. To the best of our knowledge, BD in young children has been previously reported in only 2 other publications.
糖尿病性大疱病（BD），又称糖尿病性大疱，是糖尿病的皮肤表现之一，在美国，0.5%的糖尿病患者有此表现，主要见于长期且血糖控制不佳、伴有糖尿病周围神经病变的成年男性。然而，儿童糖尿病性大疱病大多未被识别。我们报告了 1 例 3 岁 1 月女童的 BD 病例，该患儿患 1 型糖尿病，入院前已接受胰岛素治疗 7 个月。皮肤科检查显示，右侧手部外侧边缘有 1 个大而紧张的水疱，充满清亮液体，无疼痛或瘙痒，局部无创伤。在局麻下，从水疱的外周缘取 4mm 皮肤活检，组织病理学显示表皮下水疱和真皮稀疏非特异性浸润；直接免疫荧光检查补体 C3、IgM、IgG 和 IgA 均为阴性。本例的特点包括无局部创伤或任何其他糖尿病并发症，且水疱与控制良好的 1 型糖尿病有关。组织病理学、直接免疫荧光和临床转归确诊了该诊断。据我们所知，此前仅有另外 2 篇文献报道过儿童的 BD。
