蕈样肉芽肿误诊为寻常型银屑病临床分析  

Clinical Analysis of Granuloma Fungoides Misdiagnosed as Psoriasis Vulgaris

作　　者：吴明明[1] 肖晶[2] 潘翠翠[1] 沈小雁[3] 赵肖庆[3] 郑捷[3] WU Mingming;XIAO Jing;PAN Cuicui;SHEN Xiaoyan;ZHAO Xiaoqing;ZHENG Jie(Department of Dermatology,Shanxi Hospital of Traditional Chinese Medicine,Taiyuan 030012,China;Department of Hematology,Shanxi Hospital of Traditional Chinese Medicine,Taiyuan 030012,China;Department of Dermatology,Ruijin Hospital Affiliated to the Medical School of Shanghai Jiaotong University,Shanghai 200025,China)

机构地区：[1]山西省中医院皮肤科,太原030012 [2]山西省中医院血液科,太原030012 [3]上海交通大学医学院附属瑞金医院皮肤科,上海200025

出　　处：《临床误诊误治》2024年第12期8-13,共6页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨蕈样肉芽肿的临床特点及误诊为银屑病原因、防范措施。方法对误诊40年蕈样肉芽肿1例的临床资料进行回顾性分析,并复习相关文献。结果患者主因全身红斑鳞屑40年,躯干红色丘疹伴瘙痒4年就诊。40年前双下肢出现皮疹,逐渐增大为斑块,长期诊断为银屑病,治疗效果差。4年前躯干出现粟粒样丘疹伴瘙痒,外院经病理检查考虑蕈样肉芽肿,后因皮疹反复,更换部位病理检查再次诊断为寻常型银屑病,对症治疗效果差。入院后完善相关检查,明确诊断为蕈样肉芽肿(ⅣB期),调整治疗方案,目前病情稳定。结论蕈样肉芽肿早期临床及病理表现不典型,易误诊。对于非典型的或常规治疗无反应的银屑病患者,特别是在开始使用免疫抑制剂之前,建议进行组织病理及其他特异性检查以明确诊断并排除蕈样肉芽肿,降低误诊率,改善患者预后。Objective To investigate the clinical characteristics,the cause of misdiagnosis,and the preventive mea-sures of granuloma fungoides as psoriasis.Methods The clinical data of 1 patient with granuloma fungoides misdiagnosed 40 years ago were retrospectively analyzed,and the relevant literature was reviewed.Results The patient presented with ery-thematous scaly of the whole body for 40 years,and red papule of the trunk with pruritus for 4 years.Forty years ago,a rash appeared on both lower limbs,which gradually increased to plaque.The long-term diagnosis was psoriasis,and the treatment was poor.Four years ago,miliary papules with pruritus appeared on the trunk,which was considered granuloma fungoides by pathologic examination in another hospital.Later,due to repeated rashes,psoriasis vulgaris was again diagnosed by pathologic examination at different sites,and the symptomatic treatment was poor.After admission,the relevant examination was per-formed,and the diagnosis was confirmed:granuloma fungoides(stageⅣB).The treatment plan was adjusted,and the condi-tion was stable.Conclusion Early clinical and pathological manifestations of granuloma fungoides are not typical,and it is prone to misdiagnosis.For patients with atypical or unresponsive psoriasis,especially before initiation of immunosuppressant therapy,histopathological and other specific tests are recommended to confirm the diagnosis and rule out granuloma fungoi-des,so as to reduce misdiagnosis and improve patient prognosis.

关 键 词：蕈样肉芽肿 皮肤T细胞淋巴瘤 误诊 银屑病 诊断 鉴别 治疗方案 预后 

分 类 号：R733.4[医药卫生—肿瘤]