类脂质渐进性坏死1例  

Progressive necrosis of lipid: A case report

作　　者：段姣妞 杜伟 侯睿宏 许珂 张改连 张莉芸 DUAN Jiao-niu;DU Wei;HOU Rui-hong;XU Ke;ZHANG Gai-lian;ZHANG Li-yun(Department of Rheumatology and Immunology,Shanxi Bethune Hospital,Taiyuan 030032,China)

机构地区：[1]山西白求恩医院风湿免疫科

出　　处：《北京大学学报（医学版）》2019年第6期1182-1184,共3页Journal of Peking University:Health Sciences

摘　　要：类脂质渐进性坏死(necrobiosis lipoidica,NL)是一种罕见的慢性肉芽肿性疾病,临床多无自觉症状,本病与糖尿病或自身免疫性疾病有关,易被误诊为结节性红斑、硬皮病等,应引起风湿科医师的重视。A 61-year-old woman was referred to our department with a 11-year-erythra.In the anterior tibia of both lower extremities,we could see large dark red infiltrating erythema,waxy luster,clear boundary,slight central atrophy,depression and capillary dilatation.He was diagnosed with“dermatitis contusiformis”in local hospitals,but the treatment of traditional Chinese medicine and external drugs was not effective.She had normal laboratory findings for blood routine test,biochemical indexes,C reactive protein(CRP)and erythrocyte sedimentation rate(ESR).Furthermore,autoimmune antibodies were all negative.The skin pathology showed degeneration and necrosis of collagen fibers,chronic granulomatous inflammation in the dermis,and there were more acute and chronic inflammatory cell infiltration around the small vessels and in the wall of the tube.We eventually diagnosed it as necrobiosis lipoidica(NL)according to the history,erythra morphology and skin pathology.After treatment of low dose hormone and thalidomide for 1 year,the color and range of skin lesions gradually alleviated.NL was a rare chronic granulomatous inflammatory disease.There appeared to be a predominance in females.The incidence of NL was higher in patients with diabetes mellitus,although this asscoiation was currently questioned.NL might also be connected with autoimmune diseases,such as rheumatoid arthritis,sarcoidosis,ulcerative colitis and Crohn’s disease.The pathological changes of the tissue were mainly in the dermis,including necrotic type,granulomatous type or mixed type.NL typically presented on the pretibial surface of lower extremities.Less typical locations included the face,scalp,vulva and upper limbs.Leisions usually began with small papules and nodules that gradually infiltrated into brown-yellow patches and developed central wax-like atrophy.The diagnosis is often based on clinical examination and skin biopsy.NL is rare and easy to be misdiagnosed.For rheumatologists,we should carefully compare with the nodular erythema,the microscopic p

关 键 词：类脂质渐进性坏死 糖尿病 自身免疫性疾病 

分 类 号：R593.3[医药卫生—内科学]