Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Department of Dermatology, Mayo Clinic, Rochester, MN, USA.
Int J Dermatol. 2021 Nov;60(11):1385-1391. doi: 10.1111/ijd.15650. Epub 2021 May 15.
Hospitalized patients with hematologic malignancies are medically complex and commonly affected by dermatologic conditions.
Retrospective chart review from January 1, 2014, to December 31, 2018, at Rochester Methodist Hospital (Rochester, Minnesota, USA). Patients hospitalized on hematology and BMT services receiving dermatology consultation were included.
In all, 578 consultations (63% male, median age 61 years) were reviewed. Drug reactions (22%), infection (17%), and malignant neoplasm (10%) accounted for nearly half of diagnoses. Exanthematous drug reaction (10%), graft-versus-host disease (7%), and lymphoma or leukemia cutis (6%) were the commonest individual diagnoses. There were significantly more drug reactions in severe neutropenia (33.2% vs. 15.0%), neutrophilic dermatoses in myeloid neoplasm (5.2% vs. 0.3%), and viral infection in lymphoid neoplasm (8.3% vs. 1.2%). Consultation frequently altered treatment (68%), diagnostic workup (63%), and the primary service's initial diagnostic impression (53%). Biopsies were performed in 52% of consultations and helped secure a diagnosis 73% of the time. A total of 16.4% of consultations did not receive a definitive final diagnosis, and 18.5% were resolved in one visit.
This is the largest study to date of hospital dermatology consultation in hematology patients. Biopsies are utilized frequently and are diagnostically useful. The complexity of this patient population is evidenced by the fact that a final diagnosis remains elusive in a number of cases despite the multiple visits required for the vast majority of consultations. Nevertheless, dermatology consultation alters diagnosis and treatment in the majority of patients, highlighting the critical role dermatologists have in the care of these patients.
患有血液系统恶性肿瘤的住院患者病情复杂，常伴有皮肤疾病。
对 2014 年 1 月 1 日至 2018 年 12 月 31 日在美国明尼苏达州罗切斯特卫理公会医院的血液科和骨髓移植服务住院患者的病历进行回顾性图表审查。纳入接受皮肤科会诊的患者。
共回顾了 578 次会诊（63%为男性，中位年龄 61 岁）。药物反应（22%）、感染（17%）和恶性肿瘤（10%）占近一半的诊断。出疹性药物反应（10%）、移植物抗宿主病（7%）和淋巴瘤或白血病皮肤浸润（6%）是最常见的单独诊断。在严重中性粒细胞减少症（33.2%比 15.0%）、骨髓增生异常中性粒细胞皮肤病（5.2%比 0.3%）和淋巴细胞肿瘤病毒感染（8.3%比 1.2%）中，药物反应明显更多。会诊经常改变治疗（68%）、诊断检查（63%）和主要服务的初始诊断印象（53%）。52%的会诊进行了活检，73%的情况下活检有助于明确诊断。共有 16.4%的会诊未明确最终诊断，18.5%的会诊在一次就诊中解决。
这是迄今为止对血液科住院患者皮肤科会诊进行的最大规模研究。活检经常被使用，并且具有诊断价值。尽管大多数会诊都需要多次就诊，但仍有许多情况下无法明确诊断，这表明该患者群体的复杂性。然而，皮肤科会诊改变了大多数患者的诊断和治疗，这突显了皮肤科医生在这些患者护理中的重要作用。
