Boiko S, Kaufman R A, Lucky A W
Department of Dermatology, University of Cincinnati College of Medicine, OH 45267.
Arch Dermatol. 1988 Mar;124(3):418-23.
Three children with severe, secondarily infected atopic dermatitis since infancy developed osteomyelitis of the distal phalanges of the hands. The insidious onset of one or more distal subungual black macules was followed by edema, erythema, and pain in the involved fingers. No child had an elevated erythrocyte sedimentation rate or fever, but all had roentgenographic or scintigraphic evidence of bony destruction. In two children, Staphylococcus aureus grew from skin surface cultures; S aureus also grew from nail bed and osseous cultures of the distal phalanges; Streptococcus viridans grew from one child's nail bed. All children had prolonged hospitalizations. In two children, laboratory evaluation of immunologic function disclosed normal findings. We postulate that intense scratching of infected skin coupled with minor trauma to the fingertips created distal subungual microabscesses that spread contiguously to the underlying bone.
三名自婴儿期起就患有严重的、继发感染的特应性皮炎的儿童，出现了手部远端指骨骨髓炎。起初是一个或多个远端甲下黑斑隐匿出现，随后受累手指出现水肿、红斑和疼痛。没有一个孩子的红细胞沉降率升高或发热，但所有孩子都有影像学或闪烁扫描证据表明存在骨质破坏。在两名儿童中，皮肤表面培养物中培养出金黄色葡萄球菌；远端指骨的甲床和骨培养物中也培养出金黄色葡萄球菌；一名儿童的甲床培养出草绿色链球菌。所有儿童均住院时间延长。在两名儿童中，免疫功能的实验室评估结果正常。我们推测，感染皮肤的剧烈搔抓加上指尖的轻微创伤，导致远端甲下微脓肿，进而连续蔓延至下方骨骼。
