文献简介

出版社:JAMA Dermatology

作  者:Kirk A. Sidey, BA; Melissa S. J. Willis, MD; Karolyn A.Wanat,MD

编  号:

关键字:Atypical hand-foot-mouth disease

年  份:2017   点击量:164

提  供:JAMA Dermatology

文献摘要 全文翻译

A man in his 70s with a history of chronic lymphocytic leukemia (CLL) and prescribed cyclosporine, 100mg twice daily, for pure red cell aplasia was admitted for spreading painful blisters on the hands and feet. He had initially developed rhinorrhea, cough, and low-grade fever 2 weeks prior. The patient was treated with azithromycin and subsequently developed few small, pruritic blisters on the hands and feet. He went to an urgent care facility and was diagnosed as having bronchitis and prescribed doxycycline and diphenhydramine. Over the next several days, he developed worsening fever, chills, and blisters and bullae on the arms, legs, and face. He was admitted to the hospital, and the dermatology service was consulted. Physical examination revealed numerous pink to violaceous macules, papules, and patches on the palms, dorsal hands, forearms, elbows, feet, and distal lower extremities (Figure, A and B). Fewer, scattered macules were on the face, neck, trunk, upper legs, upper arms, and scrotum. Dusky bullae were seen on the bilateral dorsal aspect of the hands, fingers, toes, and heels. In the oral cavity, there was 1 violaceous macule on the right buccal mucosa and a few linear, horizontal, white lines on the left buccal mucosa. Laboratory findings revealed a white blood cell count of 25600/μL (reference range, 3700-10500/μL) and a platelet count of 12400/μL (reference range, 15000- 40000/μL). Results from a Tzanck smear from the initial lesion on the right dorsal aspects of the third finger were negative for multinucleated giant cells. A punch biopsy was performed on the anterior side of the thigh (Figure, C and D).

患者男性,70余岁,有慢性淋巴细胞性白血病(CLL)史,给药环孢素,每天2次每次100 mg,以纯化红细胞再生障碍,为防止手脚处疼痛水疱蔓延而入院。2周前,患者初期表现为流鼻涕、咳嗽和轻度发热。患者采用阿奇霉素治疗,随后手脚部出现少量小的瘙痒性水疱。患者立即去急诊,被诊断为支气管炎,给予多西环素和苯海拉明治疗。接下来几天,患者病情恶化,发热、寒战,双臂、腿部和面部出现水疱和大疱。患者入院,进行皮肤科检查。体格检查发现手掌、手背、前臂、肘、脚和下肢远端大量粉红色到紫红色斑疹、丘疹和斑块(图A和B)。面部、颈部、躯干、大腿、上臂、阴囊可见少量散在斑疹。双手背侧、手指、脚趾和脚跟可见昏暗大疱。在口腔中,右颊粘膜处可见1紫红色斑疹,左颊粘膜处可见少量水平分布的线性白色线条。实验室检查结果显示,白细胞计数25600 / μL(参考范围,3700-10500 /μL),血小板计数12400 /μL(参考范围15000 -40000 /μL)。中指右背侧最初皮损多核巨细胞Tzanck涂片均为阴性。大腿前部行钻孔活检(图C和D)。