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[大学生论坛]:红皮病型银屑病和HIV感染

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Sherrylxy 发表于 2019-1-3 23:01:04 | 显示全部楼层 |阅读模式
Erythrodermic Psoriasis and HIV Infection
红皮病型银屑病和HIV感染


A 29-year-old man presented to the dermatology clinic with a pruritic, erythematous, and scaly rash that had first appeared 2 years earlier. He had sought no medical treatment until this presentation. His medical history included eczema during childhood and seasonal allergies. He was taking no medications. A physical examination showed erythematous, violaceous plaques (Panel A) that involved more than 90% of the patient’s body-surface area, with some areas (for example, on the back) that were spared and reflect the baseline appearance of the patient’s skin (arrow, Panel B). The differential diagnosis for generalized erythema and plaque formation includes erythrodermic psoriasis, seborrheic dermatitis, and pityriasis rubra pilaris. A punch biopsy specimen obtained from two areas on the back confirmed the diagnosis of erythrodermic psoriasis. An erythrodermic papulosquamous eruption can be associated with an underlying systemic disease. In this case, testing for human immunodeficiency virus (HIV) infection was positive. The patient received highly active antiretroviral therapy as well as topical triamcinolone. At a follow-up visit 3 months later, the patient had complete clearance of the skin eruption with some residual hyperpigmentation.
一名29岁的男子在皮肤科诊所接受了2年前首次出现的瘙痒,红斑和鳞状皮疹。在此演示之前,他一直没有寻求任何治疗。他的病史包括儿童时期的湿疹和季节性过敏。他没有服用任何药物。体格检查显示红斑,紫癜性斑块(图A)涉及患者体表面积的90%以上,部分区域(例如背部)保留并反映患者皮肤的基线外观(箭头,小组B)。广泛性红斑和斑块形成的鉴别诊断包括红皮病性银屑病,脂溢性皮炎和毛发糠疹。从背部的两个区域获得的穿孔活检标本证实了红皮病型银屑病的诊断。红皮性丘疹鳞状喷发可能与潜在的全身性疾病有关。在这种情况下,人类免疫缺陷病毒(HIV)感染的检测结果为阳性。患者接受高效抗逆转录病毒疗法以及局部曲安奈德。在3个月后的随访中,患者完全清除了皮疹,并伴有一些残留的色素沉着过度。


作者:  
Alexandra A. Bowles, B.S., and Brittany Smirnov, D.O.

期刊名称:
新英格兰医学杂志发表时间:2019-1-3
N Engl J Med 2019; 380:80
DOI: 10.1056/NEJMicm1810005



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