皮肌炎误诊为肺炎1例的探讨  

A case of DM misdiagnosed as pneumonia

作　　者：王亚琼[1] 祝庆华[1] 张小瑾 唐明文[1] 贾丹[1] 陈生[1] Wang Yaqiong;Zhu Qinghua;Zhang Xiaojin;Tang Mingwen;Jia Dan;Chen Sheng

机构地区：[1]深圳市中医院,广东深圳518033

出　　处：《中医临床研究》2020年第27期64-65,共2页Clinical Journal Of Chinese Medicine

基　　金：深圳市“医疗卫生三名工程项目”,项目名称:中日友好医院晁恩祥国医大师中医肺病团队,项目编号:SZSM201812063。

摘　　要：目的:探讨皮肌炎的误诊原因,提高临床医生对该病的认识,减少临床误诊误治。方法:回顾分析深圳市中医院收治的1例误诊为肺炎的皮肌炎临床资料。结果:该例患者因发热咳嗽27 d入院,患者近27 d反复发热咳嗽,且影像学资料支持肺炎诊断,在多个医疗中心按肺炎治疗,病情无改善。患者全身多发皮疹,入院后完善皮炎谱16项:抗MDA5抗体免疫球蛋白G(ImmunoglobulinG,IgG)(+++),抗Ro-52抗体IgG(+);肌电图:轻度肌源性损害电生理改变,以累及上肢为主,周围神经传导未见明显异常。肌肉活检病理:薄层鳞状上皮局部溃疡形成,真皮浅层小血管周围少量以淋巴细胞为主的炎细胞浸润,血管周围及真皮浅层散在少量黏液蛋白样物沉积、分隔胶原。诊断为皮肌炎,予口服泼尼松及羟氯喹治疗5 d后体温下降至正常。结论:皮肌炎与多种皮肤病表现相似,合并其他疾病时诊断更加困难,临床医生应加强对皮肌炎警惕性和提高对该病的认识和了解:减少漏诊误诊率。Objective:To investigate the causes of misdiagnosis of DM,to improve the understanding of the disease among clinicians,and to reduce misdiagnosis and mistreatment.Methods:The clinical data of DM misdiagnosed as pneumonia in Shenzhen TCM Hospital were analyzed retrospectively.Results:The patient was admitted for fever and cough,and the patient had recurrent fever and cough in the recent 27 days,and the imaging data supported the diagnosis of pneumonia.The patient had multiple skin rashes all over her body.After admission,16 items of dermatitis spectrum were improved:anti-mda5 antibody IgG(+++)and anti-ro-52 antibody IgG(+).Electromyography:mild myogenic impairment electrophysiological changes,mainly accumulated upper limbs,no obvious abnormalities in peripheral nerve conduction.Muscle biopsy pathology:local ulceration was formed in the thin layer of squamous epithelium,a small amount of lymphocytic inflammatory cells infiltrated around the small vessels in the superficial dermis,and a small amount of myxoid protein-like substance was scattered around the vessels and the superficial dermis to deposit and divide collagen.The patient was diagnosed as DM and her body temperature dropped to normal after 5 days of oral prednisone and hydroxychloroquine treatment.Conclusion:DM is similar to many skin diseases,and it is more difficult to diagnose when it is combined with other diseases.

关 键 词：皮肌炎 肺炎 发热 

分 类 号：R593.26[医药卫生—内科学]