溃疡性皮肤结核八例误诊分析  

Misdiagnosis Analysis of 8 Cases of Ulcerative Cutaneous Tuberculosis

作　　者：努尔保拉提·阿曼 阿合提别克·塔布斯[1] 李剑辉[1] 李建刚[1] 周军[2] 阿不都斯木·艾沙[1] 马博[1] 陈赵慧[3] 

机构地区：[1]新疆医科大学第二附属医院普通外科,乌鲁木齐830063 [2]中山大学孙逸仙纪念医院胃肠外科,广州510235 [3]新疆医科大学第二附属医院皮肤科,乌鲁木齐830063

出　　处：《临床误诊误治》2016年第2期16-19,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨溃疡性皮肤结核的临床特点、误诊原因及其防范措施。方法回顾性分析2005年6月—2014年6月新疆医科大学第二附属医院收治的曾误诊的溃疡性皮肤结核8例的临床资料。结果本组病变均发生在小腿,病初表现为局部皮肤红斑、丘疹、结节,继而发展为溃疡、糜烂、肿胀、疼痛,均无全身结核中毒症状。在外院首诊误诊为下肢静脉曲张静脉性溃疡4例,下肢皮肤癌2例,Bowen病2例。误诊时间5-36个月,平均20.5个月。入我院后根据病史、临床表现、结核菌素纯蛋白衍生物试验、结核感染T淋巴细胞斑点试验、溃疡灶分泌物结核杆菌抗酸染色及病理检查等确诊7例,未取得病理诊断依据经诊断性抗结核治疗确诊1例。8例确诊后均给予全身正规抗结核治疗11个月,局部病灶换药治疗6-9个月痊愈,均未植皮。随访12-18个月,无复发。结论溃疡性皮肤结核较为罕见且临床表现不典型,易误诊。临床遇及病程长、久治不愈的小腿溃疡灶者应考虑到溃疡性皮肤结核,要及时行病理检查,必要时给予诊断性抗结核治疗,以早期确诊。Objective To discuss clinical characteristics,misdiagnosis factors and preventive measures of the ulcerative skin tuberculosis. Methods Clinical data of 8 misdiagnosed cases of cutaneous tuberculosis ulcerosa admitted into the Second Affiliated Hospital of Xinjiang Medical University during June 2005 and June 2014 were retrospectively analyzed. Results Common characteristics of these 8 cases were that all the lesions occurred on the lower limb. It was manifested in the local skin from erythema,papules and nodules at the beginning of the disease,and then developed into ulcer,erosion,swelling and pain,with no symptoms of systemic tuberculosis poisoning. There were 4 cases of lower limb varicose ulcer,2 cases of lower limb skin cancers and 2 cases of Bowen＇s disease were first treated and misdiagnosed by other hospitals. The misdiagnosis duration was 5 to 36 months,with an average time of 20. 5 months. Upon admission to our hospital,7 cases were diagnosed according to the medical history,clinical manifestation,the PPD test,Tuberculosis T lymphocytes spot test（ T-SPOT. TB）,ulcer lesions secretions mycobacterium tuberculosis acid-fast stain and pathological examination. However,1 case was confirmed after diagnostic anti-tuberculosis treatment,instead of the pathological diagnosis. Each case was provided with the standard anti-tuberculosis treatment for 11 months,local lesions were treated for 6 to 9 months,without skin-grafting. Followed up for 12 to 18 months,the patients had no recurrence. Conclusion The cutaneous tuberculosis ulcerous is rare without obvious clinical manifestations and tends to be misdiagnosed. In treatment of this disease with a long course or persistent uncured leg ulcers clinicians should consider cutaneous tuberculosis ulcerosa and make pathological examination. If necessary,diagnostic anti-tuberculosis treatment should be given for the benefit of early confimation.

关 键 词：结核 皮肤 误诊 静脉曲张溃疡 皮肤肿瘤 

分 类 号：R529.4[医药卫生—内科学]