瘤型麻风误诊为变应性血管炎1例  

Lepromatous leprosy misdiagnosed as allergic vasculitis:a case report

作　　者：朱倩 刘宇倩 黎静 蒋豆蔻 许宗严[3] 李祥子 Zhu Qian;Liu Yuqian;Li Jing;Jiang Doukou;Xu Zongyan;Li Xiangzi(Department of Dermatology,Shenzhen Center of Chronic Disease Prevention and Control,Guangdong Shenzhen 518020,China;Department of STD and Leprosy Control,Shenzhen Center of Chronic Disease Prevention and Control,Guangdong Shenzhen 518020,China;Department of Dermatology,Futian District Chronic Disease Prevention Institute,Guangdong Shenzhen 518110,China)

机构地区：[1]深圳市慢性病防治中心皮肤科,广东深圳518020 [2]深圳市慢性病防治中心性病麻风病防控科,广东深圳518020 [3]深圳市福田区慢性病防治院皮肤科,广东深圳518110

出　　处：《新发传染病电子杂志》2024年第5期64-67,共4页Electronic Journal of Emerging Infectious Diseases

基　　金：深圳市卫生经济学会科研基金(202432)。

摘　　要：本文报道1例25岁女性患者,下肢红斑、溃疡3年,背部丘疹、结节半年,近3年多次于外院就诊均按“变应性血管炎”诊断和治疗,效果不佳。在深圳市慢性病防治中心经皮肤组织液及组织病理检查确诊为瘤型麻风(lepromatous leprosy,LL)。因患者HLA-B 13:01检测阳性,不宜口服氨苯砜,予利福平600mg/月、莫西沙星400mg/d、氯苯吩嗪300mg/月,外加氯苯吩嗪50mg/d联合化疗,同时使用甲泼尼龙预防面神经炎,治疗期间出现Ⅱ型麻风反应,加用沙利度胺治疗后症状缓解。目前仍在随访中,皮损较前明显消退。此病例提示临床仍需进一步加强医务人员的能力培训,及早发现麻风患者,降低漏诊误诊率。电生理检查、麻风杆菌核酸检测、血清学试验、多重生物标记试验(multiplex biomarker test,MBT)试剂盒等可能在早期识别麻风患者、减少诊断延迟中具有很大潜力。This paper report a 25-year-old female patient with erythema and ulceration of lower extremities for 3 years,papules and nodules of back for 6 months.In the past 3 years,she was diagnosed and treated in other hospital for many times,all of which were diagnosed and treated according to"allergic vasculitis"with poor results.The patient was diagnosed as lepromatous leprosy(LL)by skin tissue fluid and pathological examination.Because the patient tested positive for HLA-B13:01,it was not appropriate to take dapsone orally.Rifampicin(600mg/m),moxifloxacin(400mg/d),and chlorphenphenazine(300mg/m,50mg/d)were given treatment,while methylprednisolone was used to prevent facial neuritis.During treatment,typeⅡleprosy reaction occurred,and symptoms were relieved after the addition of thalidomide.At present,the follow-up is still in progress,and the skin lesions have subsided significantly.This case suggests that we still need to further strengthen the training of medical personnel,early detection of leprosy patients,reduce the rate of missed diagnosis and misdiagnosis.Electrophysiological examination,leprae nucleic acid detection,serological tests,MBT(multiplex biomarker test)kits,etc.,may have great potential in early identification of leprosy patients and reduce diagnostic delay.

关 键 词：瘤型麻风 变应性血管炎 误诊 

分 类 号：R755.2[医药卫生—皮肤病学与性病学]