Department of Nephrology, Shanghai Baoshan District Wusong Central Hospital (Wusong Branch, Zhongshan Hospital Affiliated to Fudan University), Shanghai, 200940, China.
BMC Nephrol. 2024 Sep 3;25(1):287. doi: 10.1186/s12882-024-03738-0.
Skin conditions are common in patients on maintenance hemodialysis and those with pancreatitis. However, there is a lack of research on dermatological issues in patients who have both hemodialysis and pancreatitis concurrently.
A 62-year-old male patient with a 4-year history of maintenance hemodialysis (MHD) presented with pain and was diagnosed with acute pancreatitis and gallbladder stones. Markedly elevated blood amylase, creatine kinase, and myoglobin were noted, alongside a purplish-red skin discoloration. Treatment included inhibition of digestive fluid secretion, anti-infection measures, blood purification, fasting, rehydration, and symptomatic care. Notably, continuous renal replacement therapy (CRRT) combined with hemoperfusion (HP) was employed. The patient's dialysis effluent initially appeared red. Upon examination of the patient's peripheral blood smear, red blood cell debris was not observed. The dialysis effluent (on Day 0) was analyzed, revealing no hemoglobin (0 g/L) but an elevated myoglobin concentration of 80.4 U/L. After the therapeutic intervention, the indicators, including the blood amylase, C-reactive protein, total bilirubin, creatine kinase, and myoglobin were improved. The patient experienced resolution of sternal and upper abdominal pain within two days. After four consecutive days of CRRT and HP treatment, the skin color returned to normal, alongside improved clarity of the dialysis effluent. Subsequently, the patient's method of blood purification was reverted to conventional hemodialysis. On the eighth day of hospitalization, the patient resumed normal diet and was discharged.
In the case of the current patient with acute pancreatitis undergoing MHD, it is noteworthy to report the observation of a unique purplish-red skin discoloration. This phenomenon may be attributable to inflammation resulting from acute pancreatitis, and the retention of myoglobin within the body.
维持性血液透析患者和胰腺炎患者常出现皮肤状况。然而，同时患有血液透析和胰腺炎的患者的皮肤科问题研究较少。
一名 62 岁男性患者，有 4 年维持性血液透析（MHD）病史，因疼痛就诊，被诊断为急性胰腺炎和胆囊结石。检测到显著升高的血淀粉酶、肌酸激酶和肌红蛋白，同时出现紫红色皮肤变色。治疗包括抑制消化液分泌、抗感染措施、血液净化、禁食、补液和对症治疗。值得注意的是，采用连续性肾脏替代治疗（CRRT）联合血液灌流（HP）。患者的透析流出液最初呈红色。检查患者外周血涂片时，未观察到红细胞碎片。分析患者的透析流出液（第 0 天），发现血红蛋白（0 g/L）不高，但肌红蛋白浓度升高至 80.4 U/L。经过治疗干预，血淀粉酶、C 反应蛋白、总胆红素、肌酸激酶和肌红蛋白等指标均有所改善。患者在两天内胸骨和上腹部疼痛缓解。经过连续 4 天的 CRRT 和 HP 治疗，皮肤颜色恢复正常，透析流出液变清亮。随后，患者的血液净化方式改为常规血液透析。住院第 8 天，患者恢复正常饮食并出院。
在本例急性胰腺炎合并 MHD 的患者中，值得报告观察到独特的紫红色皮肤变色现象。这种现象可能是由急性胰腺炎引起的炎症和体内肌红蛋白潴留所致。
