麻风5例误诊分析  

Exploration on the Misdiagnosis of the Five Leprosy Cases

作　　者：翁小满[1] 刘健[1] 马东来[2] 孙秋宁[2] 袁联潮[1] 

机构地区：[1]首都医科大学附属北京友谊医院、北京热带医学研究所,北京100050 [2]北京协和医院皮肤科,北京100730

出　　处：《中国皮肤性病学杂志》2013年第8期846-849,共4页The Chinese Journal of Dermatovenereology

摘　　要：目的提高麻风及麻风反应的诊断率,以减少误诊。方法回顾性分析5例曾被误诊的麻风患者临床与实验检查资料,探讨可靠的诊断依据和剖析误诊原因。结果 2例界线类偏结核样型麻风曾被误诊为"结节病"或"其它分枝杆菌肉芽肿",是忽视了对皮损区痛、触、温觉与外周神经检查所致。1例漏诊的界线类偏结核样型麻风患者因未能选择活动性及有代表性的皮损活检,错失了特异性病变的诊断依据所致。另2例瘤型麻风并Ⅱ型麻风反应的患者,其中1例被误诊为"变应性血管炎"20余年,长期服用激素治疗导病情恶化,另1例被误诊为"淋巴瘤",但肝脏和骨髓检查提示为瘤型麻风,内脏受损。结论全面认识麻风的皮肤、黏膜、神经与内脏受累可能性,强调对疑似麻风患者应予以感觉、神经功能与皮肤组织液、活检抗酸染色检查的重要性。Objectives To improve the diagnosis of leprosy and leprosy reactions for avoiding the misdiagnosis. Meth- ods A retrospective analysis on clinical and laboratory information from the five leprosy cases misdiagnosed as other skin diseases was carried out. Results The two cases with BT leprosy were misdiagnoses as cutane- ous sarcoidosis and granoloma annulare due to absent of the peripheral nerves and sense examinations. To se- lect the anesthetic skin as the biopsy from BL patient may cause the lose of special pathological and bacterial evidence for diagnosis. The two cases with LL patients complicated type II reaction （ENL） were misdiag- nosed as ＂allergical vasculitis＂ and ＂lymphoma＂ respectively. For the former, the symptoms was aggravat- ing for twenty years and for the latter, the liver and bone marrow biopsies were revealed pathological lessons. Conclusion This report provides an opportunity to study multiple attacked on skin, mucosa, peripheral nerves and internal organs. To highlight the importance of peripheral nerves and sense examinations and Acid - Fast staining for all suspected cases as leprosy.

关 键 词：麻风 误诊分析 

分 类 号：R755[医药卫生—皮肤病学与性病学]