文献简介

出版社:JAMADermatology Clinicopathological Challenge

作  者:Kevin X. Liu, DPhil; Adam B. Raff,MD, PhD; Margaret S. Lee,MD, PhD

编  号:

关键字:Methimazole-induced vasculitis

年  份:2017   点击量:132

文献摘要 全文翻译

A young black woman with a history of Graves disease presented with painful lesions on both legs. She reported chills, bilateral lower extremity swelling, and several small, painful, “pimple-like bumps” appearing on her bilateral lower legs, which ulcerated several days later. The ulcers progressed despite a recent course of trimethoprim-sulfamethoxazole for cultures growing methicillin-sensitive Staphylococcus aureus. The patient’s medications included methimazole and atenolol, which she had been taking since her diagnosis of Graves disease 1 year prior. She had not taken other over-the-counter medications or supplements. Physical examination of her bilateral lower extremities revealed pitting edema and multiple discrete, round, dry ulcers, most with central eschars, dusky gray borders, and collarettes of scale (Figure, A). Results from the initial laboratory workup revealed elevated levels of C-reactive protein and increased erythrocyte sedimentation rate. A punch biopsy specimen of an ulcer edge demonstrated a mid- and deep dermal marked lymphohistiocytic infiltrate with neutrophils and focal abscess, suggesting a nonspecific infection. The patient was initially treated with cephalexin, mupirocin, and conservative wound care, but the eruption later worsened, with new lesions appearing on her right leg. During follow-up, an intact 4-mm papular lesion was identified on her lower right leg (Figure, B).No pathergy at the previous punch biopsy site was observed. A biopsy of the new intact papule was performed (Figure, C and D).

患者,黑人女性,有Graves疾病史,双腿出现疼痛皮损。患者自述发冷、双侧下肢肿胀,且双侧下肢可见若干小的、疼痛丘疹状结节性红斑,几天后溃烂。尽管近期采用甲氧苄啶 - 磺胺甲恶唑治疗培养物中生长的耐甲氧西林金黄色葡萄球菌,但溃疡仍继续发展。患者自一年前被诊断为Graves病开始服药,用药史包括甲巯咪唑和阿替洛尔,但未服用其他非处方药物或补充剂。体格检查示双侧下肢凹陷性水肿,且可见多个离散圆形干燥溃疡,大多中心焦痂,伴暗灰色边界和衣领样鳞屑(图A)。初始实验室检查结果显示C反应蛋白水平升高,红细胞沉降率升高。溃疡边缘钻孔活检标本示中、深层真皮淋巴组织细胞和中性粒细胞浸润伴局灶性脓肿,提示非特异性感染。患者最初接受头孢氨苄、莫匹罗星和保守的伤口护理治疗,但后来皮疹恶化,且右腿出现新的皮损。随访期间,患者右小腿出现一完整的4-mm 丘疹(图B)。先前穿刺活检部位未见过敏反应。对新的完整的丘疹进行活检(图C和D)。