误诊为系统性淀粉样变的皮肌炎1例并文献复习  

A Case of Dermatomyositis Misdiagnosed as Systemic Amyloidosis and Literature Review

作　　者：黄志鸿[1] 牛小娟 HUANG Zhihong;NIU Xiaojuan(Department of General Medicine,Donggang Branch,Lanzhou University First Hospital,Lanzhou 73000,China;Department of Traditional Chinese Medicine,The 940th Hospital of joint logistics support Force of PLA,Lanzhou 730000,China)

机构地区：[1]兰州大学第一医院东岗院区综合内科,甘肃兰州730000 [2]中国人民解放军联勤保障部队第九四〇医院中医科,甘肃兰州730000

出　　处：《中国医药指南》2023年第26期118-120,共3页Guide of China Medicine

基　　金：甘肃省青年科技基金项目(20JR10RA007)。

摘　　要：目的探讨皮肌炎(dermatomyositis,DM)的临床特点、诊治方法及误诊原因、防范措施。方法对1例曾误诊为系统性淀粉样变的皮肌炎患者临床资料进行回顾性分析。结果患者因周身皮肤出现黑色皮疹于外院住院治疗,入院后完善相关检查后,考虑为系统性淀粉样变,经给予对症治疗后,效果欠佳。并出现四肢近端肌肉疼痛,就诊于我院后完善肌电图、心肌酶谱、皮肤活检后,诊断为皮肌炎,给予糖皮质激素(强的松)联合免疫抑制剂(羟氯喹、硫唑嘌呤)治疗。2个月后复查血常规、甲状腺功能、心肌酶谱均正常,肌力好转,病情平稳。结论皮肌炎与系统性淀粉样变均可能出现皮肤损害,早期皮损不典型、无肌肉疼痛症状,且合并有其他脏器功能损害时,极易误诊。临床诊疗中,应详细询问病史、全面仔细查体、积极完善相关医技检查、认真进行鉴别诊断,并综合患者整体情况进行分析,可减少或避免皮肌炎误诊误治。Objective To investigate the clinical features,diagnosis and treatment methods,misdiagnosis reasons and preventive measures of Dermatomyositis(DM).Methods The clinical data of a dermatomyositis patient misdiagnosed as systemic amyloidosis were retrospectively analyzed.Results The patient was hospitalized in another hospital because of black skin rash.After the examination,the patient was considered to be systemic amyloidosis.After symptomatic treatment,the effect was not good.He also developed proximal limb muscle pain.After being admitted to our hospital,he was diagnosed as dermatomyositis after the improvement of electromyography,myocardial zymography and skin biopsy,and was treated with glucocorticoids(prednisone)combined with immunosuppressive agents(hydroxychloroquine and azathioprine).Two months later,the blood routine examination,thyroid function and myocardial zymogram were normal,and the muscle strength was improved and the condition was stable.Conclusions Skin lesions may occur in both dermatomyositis and systemic amyloidosis.It is easy to be misdiagnosed when the early skin lesions are atypical,without muscle pain,and complicated with other organ dysfunction.In clinical diagnosis and treatment,it is necessary to ask the history in detail,have a thorough physical examination,actively improve the relevant medical skills,make a careful differential diagnosis,and analyze the overall situation of the patient,so as to reduce or avoid misdiagnosis and mistreatment of dermatomyositis.

关 键 词：皮肌炎 系统性淀粉样变 误诊 

分 类 号：R758[医药卫生—皮肤病学与性病学]