Lee C T, Thirumoorthy T
Middle Road Hospital, Singapore.
Ann Acad Med Singap. 1988 Oct;17(4):554-6.
A case of malignant pyoderma with a fatal course is presented. A 62-year-old Chinese man was admitted with a 8-month history of progressive ulcerative nodular skin lesions starting on the right antecubital fossa and spreading to the chest, face, arms and legs. The lesions failed to respond to many antibiotics. Examination revealed multiple large crusted foul-smelling ulcers with erythematous raised vegetative edges and tender erythematous nodules. Investigations showed an anaemia of chronic disease and an erythrocyte sedimentation rate of 135mm/1st hour. Histology showed multiple circumscribed microabscesses in the upper dermis. The skin lesions responded well to systemic corticosteroid therapy. Three months after admission, he developed multiple cranial nerve palsies, and severe progressive peripheral neuropathy. Radiographic studies revealed cavitating lesion in the right upper lobe consistent with a diagnosis of carcinoma of the lung. Five months after admission, patient was intubated for stridor but he succumbed to aspiration pneumonia. Malignant pyoderma should be considered if an ulcer fails to respond to antibiotics, and possible neurological complications should be thought of.
本文报告一例恶性脓皮病致死病例。一名62岁中国男性患者，因右侧肘前窝出现进行性溃疡性结节性皮肤病变8个月入院，病变蔓延至胸部、面部、手臂及腿部。该病变对多种抗生素治疗无效。检查发现多处大的结痂、有恶臭的溃疡，边缘呈红斑状、隆起、呈疣状，还有触痛性红斑结节。检查显示存在慢性病贫血，红细胞沉降率为135mm/第1小时。组织学检查显示真皮上层有多个界限清楚的微脓肿。皮肤病变对全身皮质类固醇治疗反应良好。入院3个月后，他出现了多发性颅神经麻痹和严重的进行性周围神经病变。影像学检查显示右上叶有空洞性病变，符合肺癌诊断。入院5个月后，患者因喘鸣而行气管插管，但最终死于吸入性肺炎。如果溃疡对抗生素治疗无效，应考虑恶性脓皮病，并应想到可能的神经并发症。
