瘤型麻风误诊五年诊治反思  

Study of a 5-Year Misdiagnosis Case of Lepromatous Leprosy

作　　者：胡克 

机构地区：[1]柳城县疾病预防控制中心,广西壮族自治区柳城545200

出　　处：《临床误诊误治》2013年第1期21-23,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨麻风病的临床特点,分析误诊原因并提出防治措施,以提高本病的诊治水平。方法对1例延误诊断5年并先后误诊3次的瘤型麻风的临床资料进行回顾分析。结果本例因面部、四肢、躯干无自觉症状的斑块、结节5年余就诊。病程中在外院就诊3次,先后诊断为左鼻腔血管纤维瘤、结节性红斑、神经纤维瘤,在柳州市疾病预防控制中心经皮损组织病理检查抗酸染色麻风杆菌(++++),诊断为麻风病。后转入我中心,综合分析患者病史及症状,结合查体及组织病理检查结果,确诊为瘤型麻风,予利福平、氯法齐明、氨苯砜治疗2年后病情明显好转,皮损抗酸染色麻风杆菌转(++)。结论麻风病早期症状不典型,临床对泛发性皮肤红斑、皮下结节、鼻腔结节等患者应及早行组织病理检查及抗酸染色查麻风杆菌,以减少误漏诊。Objective To explore the clinical characteristics, cause of nfisdiagnosis and preventive measures of leprosy in order to improve the diagnosis and treatment of leprosy. Methods Clinical data of 1 patient with lepromatous leprosy misdiagnosed three times in 5 years was retrospectively analyzed. Results The patient visited a doctor for asymptomatic plaque on his face, limbs, torso and nodule for five years. He had been misdiagnosed as having left nasal angiofibroma, erythema nodosum and neurofi- broma in other hospitals. The patient was diagnosed as having leprosy by acid-fast stain leprosy bacillus （＋ ＋ ＋ ＋） of per cutem dam- aged tissues pathologic examination in Disease Control and Prevention Center of Liuzhou County. After he was transferred to our cen- tre, he was confirmed as having lepromatous leprosy by comprehensively analyzing the patient＆medical history and symptoms, com- bining with physical examination and histopathological results. His pathogenetic condition significantly improved after two years of treatment with rifampicin, clofazimine and dapsone, and the result of his skin damaged acid-fast stain leprosy bacillus was （＋ ＋）. Conclusion Leprosy tends to be misdiagnosed, so clinicians should give tissue pathologic examination and acid fast stain of leprosy bacillus to patients with skin erythema, subcutaneous nodes and nasal cavity nodes in order to reduce misdiagnosis.

关 键 词：麻风 瘤型 误诊 红斑 结节性 神经纤维瘤 

分 类 号：R755.2[医药卫生—皮肤病学与性病学]