播散性带状疱疹后肉芽肿性炎型Wolf同位反应一例  

Wolf's isotopic response manifesting as granulomatous inflammation after disseminated herpes zoster:a case report

作　　者：王淼淼[1] 杨子良[1] 周乃慧[1] 宋琳毅[1] 闵玮[1] 刘铭[1] 钱齐宏[1] 冯雪梅[1] 李敏[1] 陆一枫 Wang Miaomiao;Yang Ziliang;Zhou Naihid;Song Linyi;Min Wei;Liu Ming;Qian Qihong;Feng Xuemei;Li Min;Lu Yifeng(Department of Dermatology,The First Affiliated Hospital of Soochow University,Suzhou 215006,Jiangsu,China)

机构地区：[1]苏州大学附属第一医院皮肤科,215006

出　　处：《中华皮肤科杂志》2021年第10期887-890,共4页Chinese Journal of Dermatology

基　　金：国家自然科学基金(81703144)。

摘　　要：患者男,65岁,因右面部红肿20 d,背部、双上肢散在丘疹10 d入院。发病前20 d曾因播散性带状疱疹住院治疗。确诊慢性淋巴细胞白血病3年。皮肤科检查:右面部眼睑以下区域、耳廓及外耳道弥漫性暗红色肿胀性斑块,触之有浸润感,原带状疱疹愈合后遗留散在褐色结痂,其间可见散在凹陷性瘢痕;颈后、背部及双上肢可见散在浸润性淡红色丘疹,绿豆至黄豆大小,表面较光滑。面部皮损组织病理检查:真皮全层及皮下脂肪层可见上皮样细胞和淋巴细胞呈结节状浸润,并含较多多核巨细胞;免疫组化:CD68、CD20、CD79a、CD3、CD2、CD10、CD5、Bcl-2阳性、Ki-67散在阳性,CD23、细胞周期蛋白D1、Bcl-6.多发性骨髓瘤癌基因1、CD21、CD35、髓过氧化物酶均阴性。诊断:播散性带状疱疹后肉芽肿性炎型Wolf同位反应。治疗:静脉滴注甲泼尼龙40 mg/d,皮损逐渐好转消退,随访4年未复发。A 65-year-old male patient,who had a history of chronic lymphocytic leukemia for 3 years,presented with erythematous swelling of the right cheek for 20 days and scattered papules on the back and upper extremities for 10 days.Twenty days prior to the presentation,the patient was hospitalized for disseminated herpes zoster.Skin examination showed diffuse dark red swollen plaques in the facial area under the right eyelid as well as on the right auricle and extermal acoustie meatus,with a sense of infiltration on palpation;scattered brown crusts were left behind at the sites of healed herpes zoster lesions,and scattered depressed scars were observed among these crusts;scattered infiltrative,mung bean-to soybean-sized,light red papules with a smooth surface were seen on the back of the neck,back and upper limbs.Histopathological examination of the facial skin lesions revealed mnodular infiltration of epithelioid cells,lymphocytes and many multinucleated giant cells in the dermis and subcutaneous adipose issue;immunohistochemical staining showed positive staining for CD68,CD20,CD79a,CD3,CD2,CD10,CD5 and Bcl-2,scattered positive staining for Ki-67,and negative slaining for CD23,cyclin D1,Bcl-6,muliple myeloma oncogene 1,CD21.CD35 and myeloperoxidase.The patient was diagnosed with W olf's isotopie response manifesting as granulomatous inflammation after disseminated herpes zoster.The patient was treated with intravenous drips of methylprednisolone at a dose of 40 mg/d,and the skin lesions were gradually improved and subsided.No rcurrence was observed during 4 years of fllow-up.

关 键 词：带状疱疹 同位反应 肉芽肿性炎 

分 类 号：R752.12[医药卫生—皮肤病学与性病学]