临床少见的坏疽性脓皮病临床误诊分析  

Clinical Misdiagnosis of Pyoderma Gangrenosum,A Rare Disease in Clinical Practice

作　　者：付潇潇[1] 赵换军 王慧英 卞承浩 FU Xiaoxiao;ZHAO Huanjun;WANG Huiying;BIAN Chenghao(Department of Burn Injury,Beijing Luhe Hospital,Capital Medical University,Beijing 101100,China)

机构地区：[1]首都医科大学附属北京潞河医院烧伤科,北京101100

出　　处：《临床误诊误治》2025年第4期27-30,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的分析临床少见的坏疽性脓皮病(PG)的临床表现、诊治经过,探讨PG误诊发生原因及防范措施。方法回顾分析2022年3月至2023年11月收治的2例曾误诊的PG患者资料。结果1例中年男性,全身多处不明原因反复破溃、流脓伴疼痛,有肺结核病史,查血炎性因子升高,结合清创术中快速病理结果,初步诊断为结核性创面,予诊断性抗结核治疗但效果不明显,加用糖皮质激素后症状减轻,待会诊病理结果回报后综合分析病情诊断为PG。误诊时间15 d。停用抗结核药物,给予糖皮质激素治疗,患者预后良好。1例老年女性,因双下肢反复结节、破溃、溢液伴疼痛就诊,既往史无特殊,外院诊断为蜂窝组织炎,予抗感染、清除坏死组织等治疗后又复发,以疖肿收入院,查血炎性因子升高,轻度贫血,创面分泌物未见细菌、抗酸杆菌、真菌孢子及菌丝,分泌物细菌培养及组织真菌培养均阴性,后经皮损组织病理检查确诊为PG。误诊时间1年余。确诊后予抗感染联合糖皮质激素治疗,患者预后良好。结论PG皮损形态多样,且缺乏特异性实验室检测指标及病理学特征,诊断存在一定难度,易误诊;加强接诊医生对本病的认识及重视程度,重视组织病理学检查,加强多学科会诊理念,有利于本病的及早确诊并治疗。Objective To analyze the clinical manifestations,diagnosis and treatment of rare pyoderma gangrenosum(PG),and to discuss the causes and preventive measures of PG misdiagnosis.Methods The data of 2 patients with misdiagnosed PG who had been treated from March 2022 to November 2023 were retrospectively analyzed.Results One patient was a middle-aged male,with multiple unexplained recurrent ulceration,pus discharge and pain,and a history of pulmonary tuberculosis and elevated blood inflammatory factors.Combined with rapid pathological results during debridement,the patient was initially diagnosed as a tuberculous wound.Diagnostic anti-tuberculosis treatment was given but was not effective,and the symptoms were relieved after the addition of Glucocorticoid.After the pathological results were reported by consultation,he was diagnosed as PG through comprehensive analysis.The misdiagnosis lasted 15 d.The patient had a good prognosis after discontinuing antituberculosis drugs and receiving Glucocorticoid therapy.The other patient was an elderly female and presented with recurrent nodules,ulceration,discharge and pain in both lower extremities and without special history.The initial diagnosis was cellulitis in another hospital,which recurred after anti-infection and necrotic tissue removal treatment.The patient was admitted to our hospital as a furuncle,with elevated inflammatory factors and mild anemia through blood examination.No growth of bacteria,acid-fast bacilli,fungal spores and mycelia was found in wound secretions.Bacterial culture and tissue fungal culture were negative,and PG was confirmed by histopathological examination.The misdiagnosis lasted more than 1 year.After diagnosis,the patient was given anti-infection treatment combined with Glucocorticoid,and the prognosis was good.Conclusion The lesions of PG are varied in shape and lack specific laboratory detection indexes and pathological features,which is difficult to diagnose and prone to misdiagnosis.It is beneficial to the early diagnosis and treatment of t

关 键 词：坏疽性脓皮病 误诊 结核性创面 蜂窝组织炎 疖肿 诊断 鉴别诊断 

分 类 号：R758.6[医药卫生—皮肤病学与性病学]