合并甲状腺病变的嗜酸性筋膜炎1例及文献复习  

Eosinophilic fasciitis with thyroid disease:a case report and literature review

作　　者：熊梅 骆志成[1] XIONG Mei;LUO Zhicheng(Department of Dermatology,Lanzhou University Second Hospital,Lanzhou,Gansu 730030,China)

机构地区：[1]兰州大学第二医院皮肤科,甘肃兰州730030

出　　处：《安徽医药》2023年第5期1015-1017,I0005,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的 报告1例合并甲状腺病变的嗜酸性筋膜炎(EF)病例,为今后临床诊治提供参考。方法 兰州大学第二医院2021年4月2日收治的1例合并甲状腺疾病的女性EF病例,对相关文献进行复习。结果 女,52岁。双肩关节皮肤肿痛2月,双前臂皮肤肿胀、僵硬1月,入院检查时发现甲状腺结节。双前臂“沟槽征”,双前臂核磁共振成像示筋膜炎症性改变,外周血嗜酸性粒细胞计数0.55×10^(9)/L。甲状腺组织病理活检提示甲状腺乳头状癌、结节性甲状腺肿、桥本甲状腺炎。综上诊断为EF、甲状腺恶性肿瘤(乳头状癌)、桥本甲状腺炎、结节性甲状腺肿。给予醋酸泼尼松片和甲氨蝶呤,3月后皮损基本痊愈;并行双侧甲状腺切除+左侧中央区清扫,随访3月无复发及转移。结论 EF可能作为系统性疾病的皮肤表现,遇到此类病人除积极筛查自身免疫系统、血液系统相关疾病等常见合并症,也应该高度警惕实体肿瘤等少见合并症,早期识别各种潜在疾病。Objective To report a case of eosinophilic fasciitis(EF)with thyroid disease,and to provide reference for clinical diagnosis and treatment in the future.Methods A case of EF in a woman with thyroid disease admitted to tthe Second Hospital of Lanzhou University on April 2,2021 was reported and the literature was reviewed.Results A 52-year-old female presented with skin swelling and pain on shoulder joints for 2 months,skin swelling and stiffness on forearms for 1 month.In addition,thyroid nodules were found during admission examination.Double forearm"groove sign";magnetic resonance imaging of forearms showed inflammatory changes in fascia;Eosinophil count was 0.55×10^(9)/L.A histopathologic biopsy of the thyroid suggested papillary thyroid carcinoma,nodular goiter and Hashimoto thyroiditis.In summary,the diagnosis of EF,thyroid malignant tumor(papillary carcinoma),Hashimoto thyroiditis and nodular goiter was made.The patient was treated with prednisone and methotrexate,and the lesions were basically cured 3 months later.Bilateral thyroidectomy and left central area dissection were performed,and no recurrence and metastasis after 3-month follow-up.Conclusions EF may be a skin manifestation of systemic diseases.Patients with such manifestation should be actively screened for common complications such as autoimmune system and blood system related diseases,and should also be highly vigilant for rare complications such as solid tumors,so as to identify various potential diseases early.

关 键 词：嗜酸性筋膜炎 泼尼松 甲状腺病变 甲状腺乳头状癌 桥本甲状腺炎 

分 类 号：R581[医药卫生—内分泌] R686.3[医药卫生—内科学]