<link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/css/video-js.min.css?v=1"><link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/article/css/base.css?v=5"><link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/article/css/index.css?v=35"><link rel="stylesheet" href="https://ysz-web.yxj.org.cn/live/dist/static/base/index.css?ysz_v=2.0"><script src="https://studioyszimg.yxj.org.cn/js/dsbridge.js?v=13" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/dsBridge/main.js?v=26" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/live/dist/static/base/fun.js?ysz_v=3" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/live/dist/static/js/nativeToWeb.js?v=1" type="text/javascript"></script><div id="ysz-header" style="margin:0;overflow:hidden;"><h1 style="font-size:24px;line-height:1.8;color:#333333;word-wrap:break-word;">​全身结节伴皮肤硬化,会是什么病?| 看图诊断</h1><h2 style="font-size:16px;color:#999999;word-wrap:break-word;"><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">2022-05-18</em><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">宋德宇</em><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">原创:医学界皮肤频道</em></h2></div><p class="brief">看图诊断,快来自测!</p><section style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">诊断难度:⭐⭐⭐</span></section><section><br/></section><section><section><p style="text-align: justify;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">病例简介</span></p><p style="text-align: justify;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;"><br/></span></p></section></section><section><section><section><section><section><section><section><section><section><section><section><section><section></section><section></section><p></p><section></section><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">患者男,63岁,8年前开始发现双手背皮肤逐渐增厚,并出现蜡状光泽丘疹。皮疹于1年前泛发全身。此外,患者还合并有上肢活动障碍、指尖麻木、气促。无吞咽困难、瘙痒、疼痛等不适,无家族史。既往曾有意义未明单克隆球蛋白血症病史。</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">查体:全身皮肤广泛硬化,泛发色素沉着和红斑。前额、肩部及胸部较多丘疹、结节,直径约5mm,多数呈线状分布(图1、2)。</span></p><p><br/></p><p style="text-align: center;"><img class="rich_pages wxw-img" data-src="https://mmbiz.qpic.cn/mmbiz_png/YvFeD6T0icibIRHJX9zlkjv7eiazZkicDMibKXgeb4uDtA5uvb6ChEKQ4Ev2cFegTkUGkMALBxPdL8yXuKFibfOKA3YQ/640?wx_fmt=png" src="https://studioyszimg.yxj.org.cn/AC14B1A30180D2224545EACE5B749754.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">图1.&nbsp;头面部丘疹、结节(引自参考文献)</span></p><p><br/></p><p style="text-align: center;"><img class="rich_pages wxw-img" data-src="https://mmbiz.qpic.cn/mmbiz_png/YvFeD6T0icibIRHJX9zlkjv7eiazZkicDMibKBeKhBTWoV3ibWTr73iaDtWWfSCJbL0TlraQTia339fnXRib6CYNJlhqsSg/640?wx_fmt=png" src="https://studioyszimg.yxj.org.cn/AC14B1A30180D222471E100840160835.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">图2. 皮肤广泛硬化,有明显的深沟纹,即“沙皮狗征”(引自参考文献)</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">实验室检查:C反应蛋白升高、血沉时间加快。抗核抗体、伯氏疏螺旋体、甲状腺激素水平正常范围内。</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">组织学检查:棘层增厚,真皮全层胶原纤维增厚,大量黏蛋白沉积(图3)。</span></p><p><br/></p><p style="text-align: center;"><img class="rich_pages wxw-img" data-src="https://mmbiz.qpic.cn/mmbiz_png/YvFeD6T0icibIRHJX9zlkjv7eiazZkicDMibKFXwqzQgEqkLFqftDK79w3Ek5cn4C5icW82Abx0s3RURe4WBDxeTNU5g/640?wx_fmt=png" src="https://studioyszimg.yxj.org.cn/AC14B1A30180D22249AFC39006585DDC.jpg" alt="图片" style="margin: 0px; padding: 0px; outline: 0px; vertical-align: bottom; box-sizing: border-box ; overflow-wrap: break-word ; width: 677px ; visibility: visible ;"/></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">图3. 组织学检查:HE低倍及高倍镜下表现及阿锌蓝染色结果(下方)(引自参考文献)</span></p></section></section></section></section></section></section></section></section></section></section></section></section><section><br/></section><section><section><section><section><section><section><section><section><section style="text-align: justify;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">Q:最可能的诊断是什么?</span></section></section></section><section><section><br/></section></section><section><section><section style="text-align: justify;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">A:</span></section></section><section><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">A. 结节病</span></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">B. 系统性硬化症</span></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">C. 硬化性黏液水肿</span></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">D. 黏液性水肿</span></p></section></section></section></section></section></section><section><section><br/></section></section></section></section><section><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; overflow-wrap: break-word; white-space: normal; color: rgb(0, 0, 0); font-family: &quot;Microsoft Yahei&quot;, Helvetica, Arial, sans-serif; text-align: justify; box-sizing: border-box; -webkit-font-smoothing: antialiased; word-spacing: 1px; background-color: rgb(255, 255, 255);"><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; overflow-wrap: break-word; box-sizing: border-box; font-family: PingFangSC, PingFangSC-Regular, &quot;Noto Sans SC&quot;; -webkit-font-smoothing: antialiased;"><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; overflow-wrap: break-word; box-sizing: border-box; -webkit-font-smoothing: antialiased;"><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; overflow-wrap: break-word; box-sizing: border-box; -webkit-font-smoothing: antialiased;"><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; overflow-wrap: break-word; box-sizing: border-box; -webkit-font-smoothing: antialiased;"><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; overflow-wrap: break-word; box-sizing: border-box; -webkit-font-smoothing: antialiased;"><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word; box-sizing: border-box; -webkit-font-smoothing: antialiased;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word; box-sizing: border-box; font-family: 微软雅黑; -webkit-font-smoothing: antialiased; background-color: rgb(230, 0, 18); color: rgb(255, 255, 255);">站友们,你们Pick哪一项?欢迎下方留言</span></p></section></section></section></section></section></section><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; overflow-wrap: break-word; white-space: normal; color: rgb(0, 0, 0); font-family: &quot;Microsoft Yahei&quot;, Helvetica, Arial, sans-serif; text-align: justify; box-sizing: border-box; -webkit-font-smoothing: antialiased; word-spacing: 1px; background-color: rgb(255, 255, 255);"><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; overflow-wrap: break-word; box-sizing: border-box; font-family: PingFangSC, PingFangSC-Regular, &quot;Noto Sans SC&quot;; -webkit-font-smoothing: antialiased;"><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; overflow-wrap: break-word; box-sizing: border-box; -webkit-font-smoothing: antialiased;"><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; overflow-wrap: break-word; box-sizing: border-box; -webkit-font-smoothing: antialiased;"><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word; box-sizing: border-box; -webkit-font-smoothing: antialiased;"><br/></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word; box-sizing: border-box; -webkit-font-smoothing: antialiased;"><span class="ysz-ueditor-content" style="padding: 0px; margin: 0px; overflow-wrap: break-word; box-sizing: border-box; -webkit-font-smoothing: antialiased; line-height: 28px;">PS:留言“选项+选择理由”,版主将挑选出优质评论三名,奖励医米10-20~</span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word; box-sizing: border-box; -webkit-font-smoothing: antialiased;"><span class="ysz-ueditor-content" style="padding: 0px; margin: 0px; overflow-wrap: break-word; box-sizing: border-box; -webkit-font-smoothing: antialiased; line-height: 28px;">&nbsp;</span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word; box-sizing: border-box; -webkit-font-smoothing: antialiased;"><span class="ysz-ueditor-content" style="padding: 0px; margin: 0px; overflow-wrap: break-word; box-sizing: border-box; -webkit-font-smoothing: antialiased; line-height: 28px;">明晚九点整,我们在下期文末公布正确答案。</span></p></section></section></section></section><section><br/></section></section><section><section><section><section><section><p style="text-align: justify;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;">上期答案</span></p></section><section><p><br/></p><p></p><section style="text-align: justify;"><strong><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">诊断:D、穆兰线状萎缩性皮病。</span></strong></section><section><br/></section><section style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">穆兰线状萎缩性皮病(linear atrophoderma of Moulin,LAM)是一种沿Blaschko线分布的萎缩性皮病,好发于青年人群。与线状硬皮病不同的是,此病在起病前皮损处常无明显的炎症反应,随着疾病的发展也不会出现明显的硬化及结节。</span></section><section><br/></section><section style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">LAM缺乏特异性病理表现,表皮常大致正常,基底层可见色素增加,真皮内血管周围可有少许炎症细胞浸润,胶原纤维及弹力纤维病变往往十分轻微。</span></section><section><br/></section><section style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">根据临床及病理表现,本例可诊断为LAM。然而此病治疗手段十分有限,本例患者使用0.1%倍他米松乳膏治疗,每天2次,持续6月,仍然没有改善。</span></section><p><br/></p><section><section style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">上期参考文献:<span class="appskip" data-appskip="yxjysz" data-appskipobj="{&quot;type&quot;:18,&quot;id&quot;:0,&quot;title&quot;:&quot;&quot;,&quot;url&quot;:&quot;https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4809442/pdf/main.pdf&quot;}">Siew-Kiang, Tay Yong-Kwang. Linear atrophoderma of Moulin. JAAD Case Rep. 2016, 2: 10-2.</span></span></section><section><br/></section><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">上期文章链接:《<span class="appskip" data-appskip="yxjysz" data-appskipobj="{&quot;type&quot;:1,&quot;id&quot;:316620,&quot;title&quot;:&quot;线状萎缩伴色素沉着,会是什么病?|看图诊断&quot;}">线状萎缩伴色素沉着,会是什么病?| 看图诊断</span>》</span></p></section></section></section></section></section></section><p><br/></p><p style="padding: 0px; text-align: justify; overflow-wrap: break-word; white-space: normal; font-size: 16px; line-height: 28px; color: rgb(0, 0, 0); word-break: break-word; font-family: &quot;Microsoft Yahei&quot;, Helvetica, Arial, sans-serif; box-sizing: border-box; -webkit-font-smoothing: antialiased; word-spacing: 1px; background-color: rgb(255, 255, 255);"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word; box-sizing: border-box; font-family: PingFangSC, PingFangSC-Regular, &quot;Noto Sans SC&quot;; -webkit-font-smoothing: antialiased;">点击图片即可进入《看图诊断》专栏,查看更多精彩内容~</span></p><p style="padding: 0px; text-align: center; overflow-wrap: break-word; white-space: normal; font-size: 16px; line-height: 28px; color: rgb(0, 0, 0); word-break: break-word; font-family: &quot;Microsoft Yahei&quot;, Helvetica, Arial, sans-serif; box-sizing: border-box; -webkit-font-smoothing: antialiased; word-spacing: 1px; background-color: rgb(255, 255, 255);"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word; box-sizing: border-box; font-family: PingFangSC, PingFangSC-Regular, &quot;Noto Sans SC&quot;; -webkit-font-smoothing: antialiased;"><br/></span></p><p style="padding: 0px; overflow-wrap: break-word; white-space: normal; font-size: 16px; line-height: 28px; color: rgb(0, 0, 0); word-break: break-word; font-family: &quot;Microsoft Yahei&quot;, Helvetica, Arial, sans-serif; box-sizing: border-box; -webkit-font-smoothing: antialiased; word-spacing: 1px; background-color: rgb(255, 255, 255); text-align: center;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word; box-sizing: border-box; font-family: PingFangSC, PingFangSC-Regular, &quot;Noto Sans SC&quot;; -webkit-font-smoothing: antialiased;"></span></p><div class="appskip-wrap"><img class="appskip" data-appskip="yxjysz" data-appskipobj="{&quot;type&quot;:4,&quot;id&quot;:571,&quot;title&quot;:&quot;皮科看图诊断&quot;}" data-yxjysz="1" src="https://studioyszimg.yxj.org.cn/41n7bhfp2cs.png"/><em class="appskip-icon"></em></div><p style="padding: 0px; overflow-wrap: break-word; white-space: normal; font-size: 16px; line-height: 28px; color: rgb(0, 0, 0); word-break: break-word; font-family: &quot;Microsoft Yahei&quot;, Helvetica, Arial, sans-serif; box-sizing: border-box; -webkit-font-smoothing: antialiased; word-spacing: 1px; background-color: rgb(255, 255, 255); text-align: center;"></p><p style="padding: 0px; text-align: center; overflow-wrap: break-word; white-space: normal; font-size: 16px; line-height: 28px; color: rgb(0, 0, 0); word-break: break-word; font-family: &quot;Microsoft Yahei&quot;, Helvetica, Arial, sans-serif; box-sizing: border-box; -webkit-font-smoothing: antialiased; word-spacing: 1px; background-color: rgb(255, 255, 255);"><img src="https://studioyszimg.yxj.org.cn/mkbefa9o5t.png" data-src="https://studioyszimg.yxj.org.cn/mkbefa9o5t.png" title="" alt="" style="padding: 0px; margin: 0px auto; border: none; width: auto; box-sizing: border-box; font-family: PingFangSC, PingFangSC-Regular, &quot;Noto Sans SC&quot;; -webkit-font-smoothing: antialiased; display: inline;"/></p><!--auditorInfo-->

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