银屑病样表现的移植物抗宿主病1例

患儿男,5岁。躯干、四肢皮疹伴瘙痒1周。7个月前,因患"急性B淋巴细胞白血病"行异基因造血干细胞移植术,术后发生两次急性移植物抗宿主病,临床表现为绿豆大鲜红色丘疹,压之退色,疹间皮肤正常,曾予糖皮质激素或免疫抑制剂治疗,丘疹可消退。皮肤科情况:面、颈、躯干及四肢伸侧可见散在分布大小不一的圆形或椭圆形干燥性红斑,上覆白色鳞屑,指/趾甲无受累,Auspitz’s征阴性。皮损组织病理示:表皮不规则增厚,浆痂形成,灶性海绵水肿,灶性基底细胞液化,表皮内可见个别坏死角质形成细胞,真皮浅中层血管周围可见稀疏的单一核细胞浸润。诊断:银屑病样表现的慢性移植物抗宿主病。

A Case of Chronic Cutaneous Graft-versus-Host Disease Mimicking Psoriasis Vulgaris

A case of chronic cutaneous Graft-versus-Host disease (GVHD)mimicking psoriasis vulgaris is reported.A 5-year-old male child had itchy lesions on his trunk and limbs for a week.Seven months ago,he received allogenic hematopoietic stem cell transplantation for type B acute lymphoblastic leukemia in our hospital.He suffered from acute cutaneous GVHD after transplantation.Clinical manifestation was reddish papule, bean sizesd,with discolouration on compression.Normal skin was found between papules.The papules faded away after oral glucocorticosteroid or immunosuppressant therapy. Dermatology conditions showed:round to oval,erythematous,dry plaques of various sizes,covered with grayish white scales were scattered on his scalp, face, neck, trunk and extensor surfaces of the limbs.His nails were not involved.Auspitz’s sign was negative. Histological examination showed irregular epidermal hyperplasia,focal spongiosis and liquefaction degeneration,and single dyskeratotic cells in the epidermis. There was sparse infiltration of mononuclear cells surrounding blood vessels in upper and mid-dermis.A case of chronic cutaneous GVHD mimicking psoriasis vulgaris is diagnosed.