一名患有类风湿性关节炎的利比亚女性的坏疽样脓皮病型皮肤利什曼病：病例报告
A pyoderma gangrenous-like cutaneous leishmaniasis in a Libyan woman with rheumatoid arthritis: a case report.
作者信息
Al-Dwibe Hamida, Amro Ahmad, Gashout Aisha, El-Zurghany Ali, El-Zubi Said, El-Hashme Mohamed, Hamarsheh Omar, Maree Mokhtar
机构信息
Dermatology Department, Faculty of Medicine, University of Tripoli, Tripoli, Libya.
Faculty of Pharmacy, Al-Quds University, Jerusalem, Palestine.
出版信息
BMC Res Notes. 2018 Mar 1;11(1):158. doi: 10.1186/s13104-018-3272-2.
BACKGROUND
Several case reports describe diseases presenting with skin ulcerations, which resemble pyoderma gangrenosum especially in immune-compromised patients, often proven on further workup, to have an infective or malignant etiology. However, treatment of pyoderma gangrenosum by systemic steroids or other immunosuppressive agents may worsen the condition.
CASE PRESENTATION
We report here, a 45 year-old Libyan woman with rheumatoid arthritis on low dose steroids with pyoderma gangrenosum-like skin lesions and positive pathergy. Slit-smear was positive for Leishmania amastigotes and histopathological examination confirmed the diagnosis of cutaneous leishmaniasis. The lesions healed completely by parenteral sodium stibogluconate (Pentostam) 600 mg daily.
CONCLUSION
We report for the first time, a rare and unusual presentation of pyoderma gangrenosum like-cutaneous leishmaniasis in a patient with rheumatoid arthritis. Atypical cutaneous leishmaniasis should not be ruled out in the differential diagnosis of unresponsive skin diseases, with slit/smear and a skin biopsy is required.
背景
几例病例报告描述了一些出现皮肤溃疡的疾病，这些疾病尤其在免疫功能低下的患者中类似于坏疽性脓皮病，经进一步检查往往证实具有感染性或恶性病因。然而，用全身性类固醇或其他免疫抑制剂治疗坏疽性脓皮病可能会使病情恶化。
病例介绍
我们在此报告一名45岁的利比亚女性，患有类风湿关节炎，服用低剂量类固醇，出现类似坏疽性脓皮病的皮肤病变且有同形反应阳性。涂片检查利什曼原虫无鞭毛体呈阳性，组织病理学检查确诊为皮肤利什曼病。通过每日静脉注射600毫克葡萄糖酸锑钠（葡酸锑钠），病变完全愈合。
结论
我们首次报告了一名类风湿关节炎患者出现类似坏疽性脓皮病的罕见且不寻常的皮肤利什曼病表现。在对无反应性皮肤病进行鉴别诊断时，不应排除非典型皮肤利什曼病，需要进行涂片/涂片检查和皮肤活检。
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