Vestey J P, Turner M, Biddlestone L, McLaren K, Goulden N, Hunter J A
University Department of Dermatology, Royal Infirmary of Edinburgh, Scotland.
Clin Exp Dermatol. 1993 Nov;18(6):559-63. doi: 10.1111/j.1365-2230.1993.tb01031.x.
Two elderly male patients presented with similar, widespread, papular, granulomatous eruptions and developed myelodysplastic syndromes. The first showed histological features of diffuse granuloma annulare and had mild hypergammaglobulinaemia, slightly abnormal liver function and a leucoerythroblastic anaemia. He developed acute myeloid leukaemia (AML) secondary to a background myelodysplastic syndrome and was treated with combination chemotherapy during which his eruption settled; his AML and his skin are in remission 1 year later. The second developed a myelodysplastic syndrome and a similar rash with histological features of papular cutaneous sarcoidosis but no systemic abnormalities apart from mild hypergammaglobulinaemia, cutaneous anergy to multiple recall antigens and activation of circulating monocytes. He has remained well but his rash and myelodysplastic syndrome have persisted. These cases are interesting because of the striking similarity of their granulomatous eruptions and their associated haematological abnormalities. Patients with such disseminated, granulomatous cutaneous infiltrations should be investigated to exclude associated haematological abnormalities if there is any abnormality of their peripheral blood picture.
两名老年男性患者出现了相似的、广泛分布的丘疹性肉芽肿性皮疹，并发展为骨髓增生异常综合征。第一名患者表现出环状肉芽肿的组织学特征，伴有轻度高球蛋白血症、肝功能轻度异常和幼粒-幼红细胞性贫血。他继发于骨髓增生异常综合征背景下发展为急性髓系白血病（AML），并接受了联合化疗，在此期间他的皮疹消退；1年后他的AML和皮肤均处于缓解状态。第二名患者发展为骨髓增生异常综合征，并出现了类似的皮疹，具有丘疹性皮肤结节病的组织学特征，但除了轻度高球蛋白血症、对多种回忆抗原的皮肤无反应性以及循环单核细胞活化外，无其他全身异常。他的情况一直良好，但皮疹和骨髓增生异常综合征持续存在。这些病例很有趣，因为它们的肉芽肿性皮疹及其相关血液学异常具有惊人的相似性。对于有这种播散性肉芽肿性皮肤浸润的患者，如果其外周血象有任何异常，应进行检查以排除相关血液学异常。
