文献简介

出版社:JAMA

作  者:Michael R. Stephens, BA; Paul L. Haun, MD; Robert G. Micheletti, MD

编  号:

关键字:皮肤T细胞淋巴瘤;淋巴瘤

年  份:2019   点击量:120

文献摘要 全文翻译

A man in his 50s was referred to the dermatology clinic with a diagnosis of granuloma annulare made on the basis of prior skin biopsy results. He had been treated by a rheumatologist for poly articular inflammatory arthritis involving the wrists, metacarpophalangeal joints, and proximal interphalangeal joints, as well as fatigue and dyspnea on exertion. Examination revealed numerous, pink-purple dermal papules on the trunk and extremities, with preference for the extensor surfaces of the arms (Figure, A) and legs. No lymphadenopathy was noted. The patient reported a 5- to 7-kg weight loss without fever or sweats. His pulmonary and joint symptoms were relieved by daily oral prednisone and flared with taper below 10mg. Other medications prescribed included hydroxychloroquine, 400mg, daily for 18 months and weekly adalimumab injections for 7 months, without improvement.

患者男性,50余岁,被转诊至皮肤科,根据先前皮肤活检结果诊断为环状肉芽肿。患者曾接受风湿病学家治疗多关节炎性类风湿性关节炎,累及手腕、掌指关节、近端指间关节,以及疲劳和用力呼吸困难。检查发现躯干和四肢存在大量粉红色-紫色真皮丘疹,多发于手臂和腿伸面(图A)。未见淋巴结肿大。患者自述体重减轻5至7kg,未见发烧和出汗。每日口服泼尼松可缓解患者腹部和关节症状,并逐渐增量治疗,最高剂量为10mg。其他处方药物包括羟氯喹,400mg,每日给药,持续18个月,每周注射阿达木单抗,持续7个月,但无改善。