文献简介

出版社:JAMA Dermatology

作  者:Flora Poon, MBBS, MHSc; Olivia Espinosa, MBBS; Rubeta N. Matin, PhD, MRCP

编  号:

关键字:棘状毛发发育不良

年  份:2018   点击量:232

文献摘要 全文翻译

A woman in her 70s presented with a 1-year history of a facial cutaneous eruption initially affecting malar cheeks and eyebrows. Subsequently it spread to involve nose, chin, upper trunk, and extremities. The lesions were mildly pruritic. Her medical history included a cadaveric renal transplant 2 years earlier for end-stage renal failure. Immunosuppressant medications included mycophenolate mofetil, 200 mg, twice daily and tacrolimus, 8 mg, twice daily. Tacrolimus levels were therapeutic. Physical examination revealed multiple 1-mm flesh-colored follicular papules and keratin spines against a diffuse erythematous background affecting the face (Figure, A and B) and upper trunk. Her scalp and eyebrow hairs were unremarkable. Serology results were unremarkable. Results of skin biopsy from the right ear demonstrated dilatation and keratotic plugging of the hair infundibula with marked dystrophy and expansion of the inner root sheath. The inner root sheath cells were enlarged with irregular trichohyaline granules and apoptotic cells with abrupt cornification without formation of a granular layer (Figure, C). Immunohistochemical analysis for SV40 polyomavirus was positive (Figure, D).

患者女性,70余岁,有1年面部皮疹史,最初影响颧骨和眉毛。随后扩散至鼻子、下巴、上躯干和四肢。皮损处有轻度瘙痒感。患者病史包括2年前因终末期肾功能衰竭接受尸体肾移植手术。免疫抑制剂药物包括吗替麦考酚酯,200 mg,每日两次,和他克莫司,8 mg,每日两次。他克莫司水平具有治疗作用。体格检查显示面部和上躯干弥漫性红斑区域可见多个1 mm肤色滤泡性丘疹和角蛋白刺(图A,B)。患者头皮和眉毛不显著。血清学检查结果不显著。右耳处皮肤活检结果示毛囊扩张、角化不良、并伴有明显营养不良和内根鞘扩张。根鞘内细胞增大,可见不规则的毛玻璃样颗粒,凋亡细胞明显角化,未形成颗粒层(图C)。SV40多瘤病毒免疫组织化学分析结果呈阳性(图D)。