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慢性移植物抗宿主病(GVHD)是一种骨髓移植后常见的、严重并发症,常导致皮肤硬皮病样改变伴慢性复发性皮肤溃疡。作者报道了1例慢性GVHD 患者表现为足底溃疡的皮肤鳞状细胞癌。患者女,20岁。因左足底溃疡保守治疗9个月未愈而住院治疗。局部无外伤史,溃疡面细菌培养为假单胞菌类。患者13年前因再生障碍性贫血而接受骨髓移植。因急性 GVHD 用氨甲喋呤治疗,4个月后发生进行性硬度病样改变伴有足趾挛缩和复发性皮肤溃疡。皮肤活检证实为慢性 GVHD。体检示广泛的皮肤硬化,瘢痕性秃发、角膜混浊及所有指趾屈曲挛缩。口腔粘膜正常。右前臂有3×4cm 溃疡。左足底内侧有6×7cm 溃疡,后者中央和边缘角化过度。全血细胞计数示轻度红细胞减少。肝
Chronic graft-versus-host disease (GVHD) is a common and serious complication after bone marrow transplantation, often leading to skin scleroderma-like changes with chronic recurrent skin ulcers. The authors report a case of cutaneous squamous cell carcinoma of the foot ulcers in patients with chronic GVHD. The patient is 20 years old. He was hospitalized because of conservative treatment of left plantar ulcers that healed for 9 months. There was no history of local trauma. The bacterial culture of the ulcer surface was Pseudomonas. The patient received bone marrow transplantation 13 years ago due to aplastic anemia. Due to the use of methotrexate for acute GVHD, progressive hardness-like changes occurred with tetanic contracture and recurrent skin ulcers after 4 months. Skin biopsy confirmed chronic GVHD. Physical examination revealed extensive skin hardening, scarred alopecia, corneal opacity, and flexion and contracture of all digits. Oral mucosa is normal. The right forearm has 3 x 4cm ulcers. There is a 6×7 cm ulcer on the inner side of the left foot, and the latter is hyperkeratotic at the center and periphery. A complete blood count showed mild red cell reduction. liver