误诊为系统性红斑狼疮的瘤型麻风一例  

A case of lepromatous leprosy misdiagnosed as systemic lupus erythematosus

作　　者：施为[1] 陈明亮[1] 谢红付[1] 陈翔[1] 杨可达[1] 

机构地区：[1]中南大学湘雅医院皮肤科,长沙410008

出　　处：《国际皮肤性病学杂志》2012年第1期4-6,共3页International Journal of Dermatology and Venereology

摘　　要：报告1例女性瘤型麻风。患者女，39岁，因多关节痛，面部及上肢酱红色丘疹，斑块半年就诊，伴有光敏，发热及乏力。实验室检查：尿蛋白强阳性、血红蛋白97g/L、血小板51×109／L，补体C3为560mg／L（850～1930mg／L）、C4为103mg]L（120～360mg／L）、ANA1：160阳性。符合系统性红斑狼疮诊断条件，给予泼尼松50mg／d、沙利度胺100mg／d及羟氯喹200mg／d，治疗后系统症状改善，但皮损进行性加重，两年后逐渐出现上腭及鼻中隔穿孔等病变。最终经组织病理检查及抗酸染色确诊为瘤型麻风。提示瘤型麻风可以出现多系统损害，自身抗体阳性，必须警惕误诊为风湿性疾病：A case of lepromatous leprosy is reported. A 39-year-old female presented with sy,nmetric polyarthritis anti jelly-colored papules on the upper limbs and face accompanied by photosensitivity, fever and fatigue for haft a year. The lesions were itchy and worsened after sun exposure. Laboratnry examination revealed that the urinary prutein was strongly positive, hemoglobin level 97 g/L, platelet count 51 × 109/L, serum complement 3 （C3） level 560 mg/L （reference value： 850-1930 mg/L）, C4 level 103 mg/L （referenee value： 120-360 rag/L）, antinuclear antibody tiler 1 ： 160. Based on these findings, she was diagnosed with systemic lupus eo＇thematnsus, and treated with oral prednisone 50 rag, thalidomide 100 mg, and hydroxyehloroquine 200 mg per day. Subsequently, systemic symptom improved, whereas the skin lesions were prugressively exacerbated with the development of nasal septmn and palate perforation 2 years after the treatment. Finally. histopathological examination and aeid-fast stain eonfirmed a diagnosis of lepromatous leprosy. This case implies that leprumatous leprosy may manifest as muhisystemie damage with the presence of autoantihodies, and dermatologists should be on guard against the misdiagnosis of lepromatous leprosy as rheumatic disease.

关 键 词：麻风 瘤型 红斑狼疮 系统性 误诊 

分 类 号：R593.241[医药卫生—内科学]