文献简介

出版社:JAMA

作  者:

编  号:

关键字:副肿瘤性天疱疮

年  份:2015   点击量:79

文献摘要 全文翻译

A man in his 70s with a history of T2N2 melanoma, locally metastatic squamous cell carcinoma, and non-Hodgkin follicular lymphoma presented with weakness, a blistering erythematous eruption, and painful oral lesions of 1 month’s duration. On physical examination, the patient was in severe discomfort with limited movement owing to cutaneous pain. He was cachectic and had widespread erosions and tense and flaccid bullae with overlying crust affecting his trunk and extremities (including the palms and soles) but sparing his scalp (Figure, A). He had severe stomatitis with localized hemorrhagic lesions, shaggy erosions on the buccal and gingival mucosa, and erythematous macules on his hard and soft palates (Figure, B). Findings from laboratory tests, including a complete blood cell count and acomprehensive metabolic panel, were unremarkable except for mild anemia. Results from a computed tomographic scan of the chest and neck showed adenopathy suspicious for lymphoproliferative disorderor potentially metastatic disease. A punch biopsy for histopathologic examination (Figure, C) and direct immunofluorescence(DIF) was performed, and serum was tested for indirect immunofluorescence(IIF) on rodent epithelium (Figure, D).

患者男性,70余岁, 有T2N2黑色素瘤,局部转移性鳞状细胞癌和非霍奇金滤泡性淋巴瘤病史,表现为脆弱、红斑性疱疹和持续1个月的疼痛口腔皮损。体检发现,患者由于皮肤疼痛,感到严重不适,运动受限。患者有恶病质、广泛糜烂、紧张和松弛大疱,上覆痂皮,累及躯干和四肢(包括手掌和脚掌),但未累及头皮(图A)。患者有严重口腔炎,伴局部出血性皮损,颊和牙龈粘膜表面粗糙糜烂,且软硬腭有红斑(图B)。除轻度贫血外,实验室检查结果(包括完整全血细胞计数和全血代谢检查)均无异常。胸部和颈部的CT扫描结果显示,淋巴增生性疾病或潜在转移性疾病腺病。行穿刺活检以及组织病理学检查(图C)和直接免疫荧光(DIF)检查,并行啮齿类动物血清上皮间接免疫荧光(IIF)(图D)测试。