论文部分内容阅读
患者,男,56岁。皮疹、四肢酸痛乏力、下肢反复肿胀8月余。平素健,无诱因,病初出现面部散在红色丘疹,四肢酸痛无力,2月后症状加重,皮疹渐向四肢躯干扩散,呈斑片状红紫色丘疹,手指关节伸面见“Gottron斑丘疹”。胸肋间出现串珠状水疱疹,下肢肿胀反复发作。半年后左锁骨上出现淋巴结肿,胸部CT拟肺癌而转入院。 查体:全身皮肤散在紫红色丘疹,两下肢为主,左锁骨上淋巴结绿豆大,质硬。心肺听诊正常,肝脾未及,无腹水征,下肢明显肿胀,未引出病理反射。Hb 103g/L,WBC4×10~9/L,血沉、肝肾功能、尿常规均正常,血找狼疮细胞(-)。皮肤活检:非特异性炎症。锁骨上淋巴结活检:转移性鳞腺癌。胸部CT:左肺下叶后段2cm结节
Patient, male, 56 years old. The rash, limb weakness, repeated swelling of the lower extremities more than eight months. There are no incentives for the disease, but there are scattered red papules on the face of the disease and weakness in the limbs. After 2 months, the symptoms worsen. The rash gradually spreads to the limbs of the extremities, showing a patchy reddish purple papule. The finger joint extends to see the “Gottron rash.” There was a beaded water blisters between the rib cages, and the lower extremities swelled repeatedly. Six months later, there was a lymphadenopathy on the left clavicle. The chest CT was intended to be lung cancer and transferred to the hospital. Physical examination: The body’s skin was scattered in purple-red papules. The two lower extremities were dominant. The left supraclavicular lymph nodes had large mung beans and were hard and hard. Cardio-acne auscultation was normal, liver and spleen were not present, no ascites sign, significant swelling of the lower extremities, no pathological reflexes. Hb 103g/L, WBC4×10~9/L, ESR, liver and kidney function, and urine routine were all normal. Blood was found for lupus cells (-). Skin biopsy: non-specific inflammation. Supraclavicular lymph node biopsy: metastatic squamous cell carcinoma. Chest CT: 2cm nodules in the posterior segment of the left lower lobe