误诊为类风湿性关节炎的瘤型麻风1例  

Lepromatous Leprosy Misdiagnosed as Rheumatoid Arthritis:A Case Report

作　　者：王凡 何彩凤[1] 章王钰 袁涛 吴辰[1] WANG Fan;HE Caifeng;ZHANG Wangyu;YUAN Tao;WU Chen(Department of Dermatology,Yijishan Hospital,Wannan Medical College,Wuhu 241000,China)

机构地区：[1]皖南医学院弋矶山医院皮肤科,安徽芜湖241000

出　　处：《皮肤科学通报》2025年第1期85-88,共4页Dermatology Bulletin

基　　金：2022年皖南医学院弋矶山医院人才引进专项项目(YR202216)。

摘　　要：患者男,61岁,双手、双下肢关节痛半年,四肢皮肤结节3月。患者多次诊断类风湿性关节炎,予以甲泼尼龙等治疗后症状好转,停用后症状复发加重。皮肤结节组织病理检查结果示:真皮内可见大量上皮细胞肉芽肿,部分肉芽肿中央可见大量泡沫细胞及中性粒细胞浸润,部分肉芽肿围绕着汗腺分布;免疫组化S100染色示:神经束内组织细胞浸润;抗酸染色阳性。结合临床表现、神经系统检查、组织病理学检查及组织液抗酸染色,最终诊断:瘤型麻风伴Ⅱ型麻风反应。治疗:予以氨苯砜、利福平、氯苯吩嗪治疗,服药24个月。完成治疗后2年随访,患者四肢皮肤结节消退,关节疼痛明显改善。A 61-year-old male presented with bilateral arthralgia in the hands and lower limbs for six months,accompanied by skin nodules on the limbs for three months.Rheumatoid arthritis had been diagnosed multiple times with improvement of symptoms following treatment with methylprednisolone.However,the condition recurred and was worsened after discontinuation of the steroid.Histopathological examination of the skin nodules revealed numerous epithelial cell granulomas within the dermis,characterized by central infiltration of foam cells and neutrophils,with some granulomas localized around sweat glands.Immunohistochemical S100 staining revealed histiocytic infiltration within the nerve bundles,and tissue fluid staining was positive for antacid.Integrating the clinical manifestations,neurological examination,histopathological findings,and antacid staining results,a diagnosis of neoplastic leprosy with a type II leprosy reaction was made.The patient accepted the treatment of aminophenyl sulfone,rifampicin,and chlorpheniramine for 24 months.The nodules on the extremities subsided and joint pain resolved at the 2-year follow-up.

关 键 词：瘤型麻风 Ⅱ型麻风反应 肉芽肿 

分 类 号：R751[医药卫生—皮肤病学与性病学]