Tur E, Brenner S, Meiron Y
Department of Dermatology, Tel Aviv University, Israel.
Br J Dermatol. 1996 Feb;134(2):350-2.
A 16-year-old girl presented with long-standing purulent sinuses to the skin overlying the lacrimal ducts, which had evolved into ulcers and resulted in hypertrophic scarring. The ulcers were serpiginous, with an uneven soft floor, and undermined edges. Histological examination revealed non-caseating tuberculoid granulomas in the dermis. Cultures for Mycobacterium tuberculosis were positive. Chest X-ray did not show pulmonary involvement. Antituberculous therapy with isoniazid 300 mg/day and rifampicin 600 mg/day achieved a great improvement within 5 weeks of being started. A further improvement was seen at 4 months and complete resolution had occurred by 9 months. To the best of our knowledge, there are no other documented cases of scrofuloderma over the lacrimal system. The delay in the diagnosis emphasizes the importance of maintaining a high level of awareness.
一名16岁女孩，泪道上方皮肤长期存在脓性窦道，已发展为溃疡并导致肥厚性瘢痕形成。溃疡呈匐行性，底部柔软不平，边缘呈潜行性。组织学检查显示真皮内有非干酪样结核结节肉芽肿。结核分枝杆菌培养呈阳性。胸部X线检查未显示肺部受累。给予异烟肼300mg/天和利福平600mg/天的抗结核治疗，开始治疗后5周内病情有显著改善。4个月时进一步改善，9个月时完全消退。据我们所知，尚无泪道系统皮肤瘰疬的其他文献报道病例。诊断延误强调了保持高度警惕的重要性。
