Willardson Hal B, Buck Shannon, Neiner James
San Antonio Uniformed Services Health Education Consortium, San Antonio, TX.
Dermatol Online J. 2017 Jan 15;23(1):13030/qt4zj1n2rq.
A 64 year-old woman presented with a one-yearhistory of purpuric, atrophic, linear patches alongthe left lateral forearm. The patient had receivedtwo ultrasound-guided triamcinolone injectionsone year earlier into her left extensor pollicis brevisand abductor pollicis longus tendon sheathsfor DeQuervain tendonitis. In the seven monthsfollowing the second injection, the patient developedatrophy, purpura, and telangiectasias starting at thesite of injection and extending proximally, followingthe course of her left cephalic vein. The patient wastreated initially with amlactin and moisturizing creamcontaining alpha-hydroxy acid cream to aid in dermalrepair. Despite treatment, she continued to haveproximal progression of the atrophy and purpura.A 4mm punch biopsy revealed a normal-appearingepidermis overlying horizontal dermal fibrosis, alongwith atrophic-appearing adipocytes with accentuatedcapillaries in the subcutaneous fat, consistent witha diagnosis of corticosteroid atrophy. These grossand microscopic changes presumably resulted fromlymphatic uptake and spread of the corticosteroidfollowing the injections for tendonitis. Although localatrophy and vascular fragility are well-documentedside effects of corticosteroid injections, linear spreadof these symptoms is rarely reported, and to this pointhas not been demonstrated in the literature followingultrasound-guided steroid injection for DeQuervaintendonitis.
一名64岁女性，左前臂外侧出现紫癜性、萎缩性线性斑块，病程1年。该患者1年前因桡骨茎突狭窄性腱鞘炎，接受了两次超声引导下的曲安奈德注射，注射部位为左拇短伸肌腱和拇长展肌腱腱鞘。在第二次注射后的7个月里，患者从注射部位开始出现萎缩、紫癜和毛细血管扩张，并沿左头静脉走行向近端发展。患者最初接受了乳酸铵和含α - 羟基酸的保湿霜治疗，以帮助皮肤修复。尽管进行了治疗，她的萎缩和紫癜仍继续向近端发展。一次4毫米的打孔活检显示，表皮外观正常，其下为水平的真皮纤维化，皮下脂肪中可见萎缩的脂肪细胞和扩张的毛细血管，符合皮质类固醇萎缩的诊断。这些大体和显微镜下的变化可能是由于腱鞘炎注射皮质类固醇后，其通过淋巴管吸收和扩散所致。虽然局部萎缩和血管脆性是皮质类固醇注射的常见副作用，但这种症状的线性扩散很少被报道，到目前为止，在超声引导下注射类固醇治疗桡骨茎突狭窄性腱鞘炎的文献中尚未有相关记载。
