淋巴结结核并发丘疹坏死性结核疹一例

丘疹坏死性结核疹(PNT)是身体对其他部位(皮肤)结核分枝杆菌感染的一种免疫、过敏反应,其早期极易与变应性血管炎混淆,可依据病理活组织检查(活检)鉴别,也可行PCR检测明确诊断。该文报道1例淋巴结结核、药物性肝损害合并PNT患者,以双足皮疹为首发表现,予脱敏、对症治疗效果欠佳,追问患者既往病史并行病理活检后临床确诊。调整抗结核药及对症治疗,门诊随访未见新发皮疹。该例提示,对疑有结核分枝杆菌感染并发皮疹的患者,应警惕并发各型皮肤结核及其鉴别诊断,对无法耐受常规治疗的患者应合理调整药物配伍方案。

Papulonecrotic tuberculid complicated with lymph node tuberculosis: a case report

Papulonecrotic tuberculid （PNT） is a host immune and allergic reaction to Mycobacterium tuberculosis infection in other parts of the body. Early-stage PNT is highly likely to be misdiagnosed as allergic vasculitis, which can be identified by pathological biopsy or PCR. In this article, we reported 1 case of lymph node tuberculosis, drug-induced liver injury complicated PNT, presenting with bipedal rash as the first manifestation. Desensitization and symptomatic treatment yielded low efficacy. The medical history of the patient was inquired and clinical diagnosis was confirmed after pathological biopsy. Anti-tuberculosis drug regimen and symptomatic treatment were adjusted. No new rash was observed during the outpatient follow-up. This case prompts that for patients suspected with Mycobacterium tuberculosis infection complicated with skin rash, the possibility of complicated with various types of skin tuberculosis and the differential diagnosis should be considered. The drug regime should be properly adjusted for patients who cannot tolerate conventional treatment.