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一例罕见的皮肤瘰疬合并寻常狼疮病例。

A rare case of scrofuloderma along with lupus vulgaris.

作者信息

Sabbadini Chiara, Oberschmied Julia, Tauber Martina, Nobile Carla

机构信息

Department of Dermatology, Venereology and Allergology, Hospital Brunico, Brunico.

Department of Pathology, Central Hospital Bolzano, Bolzano, Italy.

出版信息

Dermatol Reports. 2021 Jul 29;13(3):8993. doi: 10.4081/dr.2021.8993. eCollection 2021 Nov 17.

DOI:10.4081/dr.2021.8993
PMID:34880968
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8611515/
Abstract

Cutaneous forms of tuberculosis are rare, comprising about 1-1.5% of all cases, and show a wide range of clinical manifestations. Here we present a case of a patient with left cervical ulcerated lymphadenopathy associated with a violaceous plaque in the area of the manubrium of sternum. We performed a biopsy of the plaque for histopathology, a polymerase chain reaction (PCR) to test for mycobacteria and a smear of the ulcerated lymph node. Histopathology results showed a dermal infiltrate consisting of epithelioid granulomas without necrosis, PCR was negative, and the culture was positive for . We made the diagnosis of scrofuloderma associated with lupus vulgaris. The patient was treated with an anti-tuberculous therapy with clinical regression of the lesions. Our case emphasizes the importance of recognizing that tuberculosis can occur as a primary cutaneous pathology, with a challenging diagnosis that requires the correlation of clinical findings with diagnostic testing. Transient acantholytic dermatosis (TAD) is a relatively common entity that has been also noted to occur in patients with cancer. Herein, we describe a case of transient acantholytic dermatosis occurring in a patient with a history of prostate cancer status post radiation, now being treated with combination therapy with pembrolizumab and carboplatin-pemetrexed for advanced lung adenocarcinoma. Our case emphasizes the importance of being cognizant of TAD and its associations, particularly in cancer patients.

摘要

皮肤结核较为罕见,约占所有病例的1 - 1.5%,临床表现多样。本文报告一例患者,其左颈部出现溃疡性淋巴结病,同时在胸骨柄区域伴有紫红色斑块。我们对斑块进行了活检以做组织病理学检查,进行了聚合酶链反应(PCR)检测分枝杆菌,并对溃疡性淋巴结进行了涂片检查。组织病理学结果显示真皮浸润由无坏死的上皮样肉芽肿组成,PCR检测为阴性,培养结果显示[此处原文缺失具体阳性结果]呈阳性。我们诊断为与寻常狼疮相关的皮肤瘰疬。患者接受抗结核治疗后病变临床消退。我们的病例强调了认识到结核病可作为原发性皮肤病变出现的重要性,其诊断具有挑战性,需要将临床发现与诊断测试结果相结合。暂时性棘层松解性皮病(TAD)是一种相对常见的病症,也可见于癌症患者。在此,我们描述一例患有前列腺癌放疗史的患者发生暂时性棘层松解性皮病的病例,该患者目前正在接受帕博利珠单抗与卡铂 - 培美曲塞联合治疗晚期肺腺癌。我们的病例强调了认识TAD及其关联的重要性,尤其是在癌症患者中。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9dc0/8611515/9a6baf7c71f5/dr-13-3-8993-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9dc0/8611515/12125d4a11a6/dr-13-3-8993-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9dc0/8611515/9a6baf7c71f5/dr-13-3-8993-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9dc0/8611515/12125d4a11a6/dr-13-3-8993-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9dc0/8611515/9a6baf7c71f5/dr-13-3-8993-g002.jpg

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本文引用的文献

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Cutaneous tuberculosis in Rio de Janeiro, Brazil: description of a series of 75 cases.巴西里约热内卢的皮肤结核:75 例系列描述。
Int J Dermatol. 2019 Dec;58(12):1451-1459. doi: 10.1111/ijd.14617. Epub 2019 Sep 25.
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Cutaneous tuberculosis: A great imitator.皮肤结核:一个伟大的模仿者。
Clin Dermatol. 2019 May-Jun;37(3):192-199. doi: 10.1016/j.clindermatol.2019.01.008. Epub 2019 Jan 11.
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Tuberculosis.肺结核。
Lancet. 2019 Apr 20;393(10181):1642-1656. doi: 10.1016/S0140-6736(19)30308-3. Epub 2019 Mar 20.
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Cutaneous tuberculosis overview and current treatment regimens.皮肤结核概述及当前治疗方案
Tuberculosis (Edinb). 2015 Dec;95(6):629-638. doi: 10.1016/j.tube.2014.12.006. Epub 2014 Dec 25.
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Cutaneous tuberculosis: epidemiologic, etiopathogenic and clinical aspects - part I.皮肤结核:流行病学、病因病理及临床方面——第一部分
An Bras Dermatol. 2014 Mar-Apr;89(2):219-28. doi: 10.1590/abd1806-4841.20142334.
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Current methods in the molecular typing of Mycobacterium tuberculosis and other mycobacteria.结核分枝杆菌及其他分枝杆菌分子分型的当前方法。
Biomed Res Int. 2014;2014:645802. doi: 10.1155/2014/645802. Epub 2014 Jan 5.
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Evolution of cutaneous tuberculosis over the past 30 years in a tertiary hospital on the European Mediterranean coast.过去 30 年在地中海欧洲海岸的一家三级医院的皮肤结核演变。
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Management of cutaneous tuberculosis.皮肤结核的管理
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Rapidly developing giant sized lupus vulgaris on the chest associated with bilateral scrofuloderma on the neck.胸部迅速发展的巨大寻常狼疮,伴有颈部双侧皮肤结核。
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