文献简介

出版社:JAMA Dermatology

作  者:Jack P. Guccione, BS; Brian Holloway, MD; Jack L. Guccione,MD, MPH

编  号:

关键字:Subcutaneous sarcoidosis

年  份:2017   点击量:100

文献摘要 全文翻译

A 40-year-old man of Scandinavian descent presented with enlarging, nonpainful upper extremity nodules developing over the preceding 9 months (Figure, A). He was renovating a commercial cannabis grow-house in California at time of onset. He described the construction site as being filled with intoxicating mold. He reported shortness of breath and a 20-pound weight loss. He denied recent travel or aquarium exposure. Most concerning was the inability to use his right upper extremity. Also, he developed a pathological fracture of his right foot (Figure, B). Clinical examination of his forearms revealed several yam-size (4-6 cm), nontender, nonulcerated, boggy subcutaneous nodules in a sporotrichoid pattern and large nodules scattered on his trunk and abdomen. There was no palpable lymphadenopathy or lower extremity lesions. His medical history is significant for diabetes mellitus type 2 and hypothyroidism. Medications included glipizide, metformin, and levothyroxine.

患者男性,40岁,斯堪的纳维亚人,9个月前上肢出现肿大无痛结节(图A)。他为加利福尼亚州的一家贸易性大麻种植园进行整修。患者自述在种植园内人很兴奋,让他感到气促、体重减轻20磅,且他否认近期进行旅行和去过水族馆。患者最关心的是右上肢失用。此外,患者右脚出现病理性骨折(图B)。其前臂临床检查发现若干山药大小(4-6厘米)、无痛未溃烂皮下结节,呈孢子菌丝样,且躯干和腹部散布大结节。患者无显著淋巴结病和下肢病变。患者有严重2型糖尿病和甲状腺功能减退病史。其用药史包括格列吡嗪、二甲双胍和左甲状腺素。