Fraticelli Paolo, Benfaremo Devis, Cardinali Marco, Gabrielli Armando
Dipartimento di Medicina Interna, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche Facoltà di Medicina e Chirurgia, Ancona, Italy.
BMJ Case Rep. 2019 Oct 8;12(10):e232005. doi: 10.1136/bcr-2019-232005.
We report the case of an otherwise healthy 60-year-old man presenting with fever, leucocytosis and a painful swelling of the right calf. We initially performed cultural and cytological examination of the popliteal fossa mass, but the results were disappointingly inconclusive. The subsequent development of several erythematous subcutaneous nodules, rapidly evolving to broad ulcerative lesions, prompted us to reconsider the clinical setting as a whole, which included fever, marked leucocytosis and multiple subcutaneous nodules. A biopsy of the ulcerative lesions finally led to the diagnosis of neutrophilic panniculitis, which was sustained by a hybrid myelodysplastic/myeloproliferative disorder like BCR-ABL1-negative atypical chronic myeloid leukaemia. The patient was initially treated with high-dose intravenous corticosteroids, resulting in a dramatic improvement of the skin lesions and normalisation of blood tests. Azacytidine treatment was subsequently started, and the haematological disease remained stable.
我们报告了一例60岁健康男性病例，该患者出现发热、白细胞增多以及右小腿疼痛性肿胀。我们最初对腘窝肿块进行了培养和细胞学检查，但结果令人失望，未得出明确结论。随后出现了几个红斑性皮下结节，并迅速发展为广泛的溃疡性病变，这促使我们重新全面考虑临床情况，包括发热、明显的白细胞增多和多个皮下结节。对溃疡性病变进行活检最终确诊为嗜中性脂膜炎，其由一种混合性骨髓增生异常/骨髓增殖性疾病（如BCR-ABL1阴性非典型慢性髓性白血病）所致。患者最初接受了大剂量静脉注射皮质类固醇治疗，皮肤病变得到显著改善，血液检查结果恢复正常。随后开始使用阿扎胞苷治疗，血液系统疾病保持稳定。
