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題 名 | 多發性尋常性狼瘡=Multiple Lupus Vulgaris |
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作 者 | 林杰慧; 許智恭; 蔡呈芳; | 書刊名 | 中華皮膚科醫學雜誌 |
卷 期 | 16:4 1998.12[民87.12] |
頁 次 | 頁313-318 |
分類號 | 415.67 |
關鍵詞 | 皮膚尋常性狼瘡; Lupus vulgaris; Mycobacterium tuberculosis; |
語 文 | 中文(Chinese) |
中文摘要 | 皮膚尋常性狼瘡(lupus vulgaris)之典型表徵為頭頸部單發性斑塊,然而,我們 報告了一例瀰漫性結核病例,且合併以兩側前臂多發性病灶為主要表現之非典型尋常性狼瘡 。病患為 76 歲男性,主訴近二週之持續發燒、合併意識逐漸模糊不清、及兩側前臂出現十 二處無症狀之紅棕色斑塊,併有表面輕度鱗屑。皮膚病理切片顯示真皮層為肉芽腫性發炎反 應,可見多核巨細胞及慢性發炎細胞浸潤。特殊染色於真皮層可見少數抗酸性桿菌。胸部 X 光呈現多發性結節分布於二側肺野,痰液檢查可見抗酸性桿菌。腰椎穿刺腦脊髓液呈疑似結 核性腦膜炎。痰液及皮膚切片經六週培養,確認為結核桿菌。臨床診斷為肺結核、皮膚尋常 性狼瘡及疑似結核性腦膜炎。給予口服抗結核菌藥物isoniazid, rifampicin, pyrazinamide, ethambutol,治療後二週,皮膚病灶獲得明顯改善,且無新病灶發生。然而 ,病患不幸因肝硬化合併大量上腸胃道出血及呼吸衰竭,於一個月後病逝。此病例不尋常之 表現方式,提醒臨床醫師須具有高度警覺性,以期對皮膚結核病達到早期診斷、早期治療的 目的。 |
英文摘要 | Lupus vulgaris, a type of cutaneous tuberculosis, typically presents itself as solitary skin lesion over the head or neck. We herein report an unusual case of lupus vulgaris with twelve patches and plaques over both forearms. This 76-year-old male patient arrived at our hospital due to persistent fever, progressive conscious disturbance and skin eruptions. Multiple red-brownish asymptomatic patches and plaques with scanty scales on both forearms for 2 weeks were complained. The histopathological picture of skin biopsy showed dermal granulomatous inflammation with multinucleated giant cells. Acid-fast stain disclosed few acid-fast bacilli. The chest X-ray film showed multiple nodular lesions over bilateral lung fields. Mycobacterium tuberculosis was isolated from the skin biopsy and sputum specimen. The microscopic and biochemical findings of the cerebrospinal fluid supported the diagnosis of tuberculous meningitis. Under the impression of disseminated tuberculosis with lupus vulgaris, pulmonary tuberculosis and tuberculous meningitis, anti-tuberculous chemotherapy including isoniazide, rifampicin, ethambutol and pyrazinamide was initiated with good response. However, the patient died of cirrhosis of the liver with massive bleeding from the upper gastrointestinal tract and acute respiratory failure one month later. |
本系統中英文摘要資訊取自各篇刊載內容。