增殖性脓性皮炎-脓性口炎一例

【摘要】 患者女，58岁，唇、头皮、皱褶部位反复发生红斑、脓疱、增殖性斑块3个月。患者有溃疡性结肠炎病史2年，皮疹发生前肠炎加重。皮肤科检查：双唇弥漫性增厚，上有密集米粒至绿豆大脓疱，部分脓疱融合，唇缘黄色结痂；左颊黏膜有一1.5 cm × 2 cm的增殖性斑块，边缘脓疱呈环状排列；头皮、颈、左腋窝、脐周、左腹股沟可见多发性大小不等的增殖性斑块、糜烂、黄色结痂，中央和边缘有环状排列的水疱和脓疱，皮疹消退后留色素沉着斑；右腋4个新发脓疱。下唇缘皮损组织病理学检查：表皮轻度增厚伴中性粒细胞微脓肿，真皮密集混合性炎症细胞浸润，可见中性粒细胞和嗜酸性粒细胞微脓肿；下唇皮疹边缘正常皮肤直接免疫荧光检查阴性。血常规检查示嗜酸性粒细胞比例增高。脓疱细菌、真菌培养阴性。诊断：增殖性脓性皮炎-脓性口炎。 【关键词】 增殖性脓性皮炎-脓性口炎

Pyodermatitis-pyostomatitis vegetans: a case report

LUO Su-ju, LI Yan, ZHOU Zhi-hai, LIU Quan-zhong. Department of Dermatology, Tianjin Medical University General Hospital，Tianjin 300052, China Corresponding author: LIU Quan-zhong, Email: quanzhongliu2008@163.com 【Abstract】 A 58-year-old female was admitted to the hospital for a 3-month history of erythema, pustules and vegetating plaques on the lips and scalp, as well as in intertriginous areas. She had a 2-year history of ulcerative colitis, which had been aggravated before the development of skin lesions. Skin examination demonstrated diffuse thickening of both lips covered with multiple granule- to mung bean-sized confluent pustules. Yellow crusts were observed at the lip margins. A 1.5 cm × 2 cm vegetating plaque surrounded by anular pustules was found in the left buccal mucosa. There were multiple irregularly-sized vegetating plaques with erosions and yellow crusts on the scalp, neck, as well as in the periumbilical and left inguinal and axillary region, and annular vesicles and pustules were observed in the center and margin of these plaques. The lesions subsided leaving hyperpigmented macules. There were four fresh pustules in the right axillary region. Histological examination of a biopsy specimen taken from the lower lip margin revealed mild hyperplasia of and neutrophil microabscess in the epidermis, as well as a dense inflammatory infiltrate composed mostly of neutrophils and eosinophils with microabscess formation in the dermis. Direct immunofluorescence examination of the normal-appearing skin next to the lesions was negative. The percentage of peripheral blood eosinophil was slightly elevated. Bacterial and fungal cultures of pustular contents were negative. A diagnosis of pyodermatitis-pyostomatitis vegetans was made. 【Key words】 Pyodermatitis-pyostomatitis vegetans