淋巴结结核并发丘疹坏死性结核疹一例

张婷?张敏?郝玉琴

【摘要】丘疹坏死性结核疹（PNT）是身体对其他部位（皮肤）结核分枝杆菌感染的一种免疫、过敏反应，其早期极易与变应性血管炎混淆，可依据病理活组织检查（活检）鉴别，也可行PCR检测明确诊断。该文报道1例淋巴结结核、药物性肝损害合并PNT患者，以双足皮疹为首发表现，予脱敏、对症治疗效果欠佳，追问患者既往病史并行病理活检后临床确诊。调整抗结核药及对症治疗，门诊随访未见新发皮疹。该例提示，对疑有结核分枝杆菌感染并发皮疹的患者，应警惕并发各型皮肤结核及其鉴别诊断，对无法耐受常规治疗的患者应合理调整药物配伍方案。

【关键词】结核疹;淋巴结结核;鉴别诊断;治疗

Papulonecrotic tuberculid complicated with lymph node tuberculosis： a case report Zhang Ting， Zhang Min， Hao Yuqin. Graduate School of Inner Mongolia Medical University， Huhtto 010000， China Corresponding author， Zhang Min， E-mail： nmgzm@ 126. com

【Abstract】Papulonecrotic tuberculid （PNT） is a host immune and allergic reaction to Mycobacterium tuberculosis infection in other parts of the body. Early-stage PNT is highly likely to be misdiagnosed as allergic vasculitis， which can be identified by pathological biopsy or PCR. In this article， we reported 1 case of lymph node tuberculosis， drug-induced liver injury complicated PNT， presenting with bipedal rash as the first manifestation. Desensitization and symptomatic treatment yielded low efficacy. The medical history of the patient was inquired and clinical diagnosis was confirmed after pathological biopsy. Anti-tuberculosis drug regimen and symptomatic treatment were adjusted. No new rash was observed during the outpatient follow-up. This case prompts that for patients suspected with Mycobacterium tuberculosis infection complicated with skin rash， the possibility of complicated with various types of skin tuberculosis and the differential diagnosis should be considered. The drug regime should be properly adjusted for patients who cannot tolerate conventional treatment.

【Key words】Papulonecrotic tuberculid;Lymph node tuberculosis;Differential diagnosis;Treatment

丘疹壞死性结核疹（PNT）常见于青壮年人群，临床特征为好发于四肢的丘疹、脓疱或坏死性病变，有结痂，可对称分布，是一种具有潜伏性的结核疹[1]。这类患者体内多有不明确结核灶，且以非特异皮疹就诊，故漏诊率、误诊率较高。笔者对我科诊治的1例以双足皮疹为首发表现的淋巴结结核患者进行报道，以期提高对典型PNT及其鉴别诊断的认识，重视既往病史的询问，且对于不典型的PNT患者也有助于尽早发现体内潜在的结核灶，以免延误病情。

病例资料

一、病史及体格检查

患者女，35岁。因双足部散在丘疹25 d于2021年1月13日就诊于我科。患者于2020年12月20日无明显诱因出现双足部散在孤立、暗红色绿豆大小的丘疱疹，偶有中心破溃成深褐色结痂，病初未重视。随后皮疹逐渐增多，皮肤及关节无疼痛、瘙痒、红肿，无干咳、咳痰、午后低热、乏力、冷汗。……