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蜘蛛咬伤呈现为发烧,巨细胞激活综合征和皮肤
Marco Fedele1,2,3,4, Mariangela Antonelli2, Egidio Carbone1
1Institute of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
概括
不明来源的发烧可能是由蜘蛛咬伤引起的,比如松症,这可能会模仿淋巴瘤. 重复的活检对于准确诊断死性皮肤病变和发烧至关重要,避免误诊.
科学领域:
- 皮肤病学 皮肤病学
- 在瘤学瘤学.
- 传染性疾病 传染性疾病
背景情况:
- 源不明发烧 (FUO) 存在诊断挑战,感染是常见的原因.
- 关节动物的咬伤,特别是来自小提琴蜘蛛的松,越来越多地被认为是FUO的原因.
- 洛克索塞尔症可以表现为皮肤或全身性疾病,包括发烧,贫血和巨细胞激活综合征 (MAS).
研究的目的:
- 为了突出诊断的复杂性,在发烧未知来源的病例与死角性皮肤病变.
- 强调在FUO中考虑传染病和恶性病因的重要性.
- 强调重复活检在实现确诊的关键作用.
主要方法:
- 一个71岁的老人呈现FUO,关节痛和死角性皮肤病变的案例研究.
- 最初的诊断工作包括实验室检测,计算机断层扫描和皮肤/淋巴结活检.
- 治疗涉及经验性抗生素,其次是MAS的皮质类固醇,随后进行了他的病理学重新评估.
主要成果:
- 对传染病的初步调查结果是负面的,经验性抗生素是无效的.
- 患者患上了MAS,对皮质类固醇治疗有反应,最初导致了松症的诊断.
- 第二次活检最终揭示了原发性皮肤形大细胞淋巴瘤 (PC-ALCL).
结论:
- 死性皮肤病变和淋巴腺病症需要进行彻底的检查,包括活检,以排除恶性病变.
- 错误诊断的loxoscelism是常见的,并且最终的诊断需要识别蜘蛛.
- 不确定的活检结果应促使重复手术以防止诊断错误并确保适当的管理.
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