【作者】 童汉云；

【导师】 徐世正；

【作者基本信息】 武汉大学 ， 皮肤病与性病学， 2004， 硕士

【摘要】 患者，女，47岁，住院号498534。因发热4天，面部、四肢散发疼痛性红色斑块3天于2002年12月28日以Sweet综合征收入院。患者于2002年12月24日无明显诱因，突然感畏寒，发热，当日体温未测，亦未治疗，次日面部和四肢出现斑块伴疼痛，此后症状加重。12月27日来我院就诊，初诊为结节性红斑，给予“川芎嗪片，穿王消炎片”等口服，未见好转，皮疹继续增多，12月28日再次来我院复诊，考虑为Sweet综合征，收院治疗。该患者有高血压病史，甲状腺乳头癌术后2年，既往无药物过敏史，无肝炎结核病史。 体检：体温37．6℃，脉搏98次／分，呼吸19次／分，血压130／70mmHg，神志清楚，口腔无溃疡，心肺听诊未见异常，肝脾肋下未触及。皮肤科检查：双眼睑、额部、双手背可见散在红色斑块，边缘隆起，部分呈假性水疱样损害，斑块小如蚕豆大小，大至2cm~4cm，圆形或卵圆形，触之中等硬度，有触痛。右小腿可见结节性损害，触痛(见图1)。 实验室检查：常规检查见附表1。尿粪常规正常。C反应蛋白为阳性。甲胎蛋白，T3、T4、TSH正常，癌胚抗原，乳腺癌相关抗原，卵巢癌相关抗原，及胃肠癌相关抗原等项检查均阴性。住院期间，两次胸部正位片正常，肝、胆、脾、肾、输卵管、膀胱B超未见异常。骨髓细胞学检查属正常骨髓象，甲状腺B超无异常。2002年12月31日左前臂皮损部位行活检，病理活检报告：表皮角化过度，角化不全，真皮乳头高度水肿，真皮密集的成熟中性粒细胞浸润，有核尘，并可见毛细血管扩张。诊断：Sweet综合征(见图2、图3、图4、图5)。 入院后给予抗感染治疗，克林霉素注射剂1．5g静脉滴注，每日一次。入院2天体温波动在37．6．38．5℃，皮损无好转，而患者特征性皮疹及实验室检查基本符合Sweet综合征的诊断，加用强的松30mg，每日一次，当日夜间体温正常，2天后斑块颜色明显减退，触痛明显减轻，用药9天后，斑块变小变平，颜色基本消退，无触痛。但患者于2003年元月8日诉咳嗽，2天后原部位皮疹复发，加用秋水仙碱0．5mg，每日3次，用药一周后皮损改善，秋水仙碱减量为0．5mg，每日2次。2周后无新发皮疹出现，患者于2003年2月1日出院。门诊定期随诊，秋水仙碱逐渐减量，于2月10日停用，改用碘化钾10mL，每日3次，强的松逐渐减量，于6月2日停用强的松及碘化钾，皮损无复发。更多还原

【Abstract】 The patient, 47 years old, was a female. She was diagnosed as Sweet’s syndrome and hospitalized on December 28, 2003, because of fever for 4 days and distributive painful red plaque on the face and extremities for 3 days. 4 days before hospitalization the patient without any cause suddenly began to feel chilly and have fever but have not measured her temperature. Without any treatment, painful skin eruption occurred on the face and limbs next day. After that the symptoms didn’t get any remission. Then on December 27, she was diagnosed as erythema nodosum in our hospital and administrated orally with ligustrazine tablets and Chuanwang eliminate inflammation tablets. However, the next day skin eruption was gradually increased. So she was hospitalized into our hospital with Sweet’s syndrome. The patient had no history of drug allergy. She had history of hypertension and had been operated 2 years ago due to papillary carcinoma of thyroid.Physical examination T 37.6, P 98 /min, R 19 /min, BP 130/70mmHg. Her mind was clear .She had not oral aphthae. Ausculation of heart and lung wasn’t found abnormality and liver and spleen were not touched under rib.Dermatologic examination Scattered red plaques with margin border some of which had pseudovesicular lesions were found on the eyelids, frontal part and both bank of the hands. Some were as small as broad bean and some were as big as 2cmx4cm. These plaques were round or ellipse and had middle consistency and tenderness. Nodose lesions were observed on the right leg and had tenderness.Laboratory findings On December 28, WBC 11.9xl09/L, N 81.7%, L 11.0%. On December 29, 2003, WBC 9.0x109/L, N 90.6%, L 7.4%. On January 7, 2003, WBC8.2x 109/L, N66.7%, L22.2%. On January 14, 2003, WBC 10.4xl09/L, N91.4%, L6.1%. On December 29, Urine and stool routines were normal and GPT and GOT in blood serum were 109U/L, 16 U/L, respectively. On January 7, 2003, GPT and GOT in blood serum were 55U/L, 16 U/L, respectively. On January 14, 2003, liver function was normal. On December 29, erythrocyte sedimentation rate was 78mm/h. On Jan 7, 2003, erymrocyte sedimentation rate became 29mm/h. On January 14, erythrocyte sedimentation rate was normal and C-response protein was positive, a -fetal protein, T3, T4, TSH, carcinoembryonic antigen, breast cancer-associated antigen, ovary-associated antigen and gastrointestinal cancer-associated antigen were normal. During hospitalization, upright chest x-ray was normal for two times and B ultrasound showed no abnormality in liver, bile duct, spleen, kidney, uterine tube, bladder and thyroid. Cytology examination of bone marrow showed normal features. On Dec 31, 2002, biopsy of cutaneous lesions on left forearm showed hyperkeratosis of epidermis, parakeratosis, severe edema of dermal papillae, intensive infiltration of mature neutrophil in dermis, nuclear dust and capillary telangiectasia. The diagnosis of Sweet’s syndrome was given.Corticosteroids should be carefully used because the patient had hypertension and post-operation of papillary carcinoma of thyroid for 2 years. After hospitalization anti-infectious treatment was given and 1.5g clindamycin was intravenously administrated daily. In the first two days the temperature had fluctuated from 37.6 to 38.5 and cutaneous lesions had no improvement.The patient’s characteristic skin lesions and laboratory examination were coincident with the diagnosis of Sweet’s syndrom. After treatment with addional 30 mg prednisone daily, fever didn’t occur in the same night and for 2 days the color of plaque markedly declined with relief of tenderness. After drug administration for 9 days, the plaques became small and flat without any tenderness and their color faded on the whole. However, the patient complained of cough on January 8, 2003 and cutaneous eruption relapsed on the original locus. Then 0.5 mg colchicine was given three times per day and cutaneous lesions began to relieve after one week’s treatment. After that, colchicine was decreased to 0.5 mg two times each day. 2 weeks later, no new skin eruption oc更多还原