文献简介

出版社:JAMA

作  者:AshleyM.DiLorenzo,MD;HelenaB.Pasieka,MD,MS;MichaelA.Cardis,MD

编  号:

关键字:

年  份:2020   点击量:133

文献摘要 全文翻译

A woman in her 70s presented with a week of painless, rapidly progressive, edematous, necrotic papules and plaques on the extremities, buttocks, and face with sharp demarcation at the nasolabial folds and extension into the oral mucosa (Figure, A and B). Notable symptoms included 4 months of extreme fatigue, 20.4 kg weight loss, and a recent episode of hematochezia. Her medical history included diabetes, hyperlipidemia, and hypertension that were well controlled with simvastatin, chlorthalidone, hydralazine hydrochloride, lisinopril, and verapamil hydrochloride. She had been taking these medications for 5 years with no new exposures. Age-appropriate cancer screening was up to date. She was afebrile and hemodynamically stable, but laboratory evaluation revealed that she had leukocytosis, normocytic anemia, elevated erythrocyte sedimentation rate, and proteinuria. On hospital day 2, she developed bright red blood per rectum, necessitating transfusion. A computed tomography of the chest, abdomen, and pelvis revealed parenchymal lung nodules. On admission, punch biopsies of the skin were performed for both histological examination and bacterial, fungal, and acid-fast bacterial cultures (Figure, C and D).

患者女,70余岁,因四肢、臀部无痛、快速进展水肿、坏死性丘疹和斑块出现一周,鼻唇皱襞处明显分界线并延伸至口腔粘膜(图A和B)而就诊。明显症状包括4个月极度疲劳,体重减轻20.4kg以及最近出现的便血。患者有糖尿病、高血脂和高血压病史,且采用辛伐他汀、氯噻酮、盐酸肼屈嗪、赖诺普利和盐酸维拉帕米治疗病情得以很好控制。患者已服用这些药物5年,未接触其他药物。进行了最新适合年龄的癌症筛查。患者既往体健,血流动力学稳定,但实验室检查显示白细胞增多,正常红细胞性贫血,血沉升高和蛋白尿。住院第二天,患者直肠周围出现鲜红血液,需要输血治疗。胸部、腹部和骨盆计算机断层扫描显示实质肺结节。入院时,对皮肤进行穿孔活检,以进行组织学检查以及细菌、真菌和耐酸细菌培养(图C和D)。