摘要患者女,62岁.面、躯干及四肢红色斑丘疹10年,加重2年.患者有类风湿关节炎病史20年,同时合并有干燥综合征、Ⅱ型糖尿病、间质性肺炎、慢性肾功能不全等疾病.皮肤科检查:面颈、躯干、四肢泛发粟粒至绿豆大小水肿性红斑、丘疹、斑丘疹,局部散在浸润性结节,以背部为著.双上肢伸侧、双膝及股臀部弥漫大片暗红斑.双手足、肘膝关节、双耳等处可见鸽卵大小暗红色或黑褐色疼痛性结节.类风湿因子阳性.皮损组织病理示,真皮上部弥漫淋巴细胞、中性粒细胞浸润,可见少许核尘及红细胞外溢,无血管炎表现.结合病史、皮损特点、实验室检查、皮损组织病理检查,确诊为类风湿性嗜中性皮炎.

abstractsA cage of rheumatoid neutrophilic dermatitis is reported.A 62-year-old woman presented with multiple erythematous papules on the trunk and extremities for 10 years.Two years prior to the Ⅱ diabetes mellitus,interstitial pneumonia and chronic renal insufficiency.The patient clinically presented with generalized millet-to mung bean-sized edematous erythema,papules,maculopapules over the faciocervical area,extremities and trunk.Infiltrated nodules were locally scattered,especially on the back.There were diffused,large dark-erythematous patches on the extensor surface of both limbs,knees,thigh and buttock,as well as pigeon egg-sized,dark erythematous or pitchy,painful nodules on both elbows,knees,hands,feet and aural region.Rheumatoid factor was positive.Histological examination demonstrated a dense and diffuse infiltration of lymphocytes and neutrophils in upper dermis;nuclear dust and extravasation of erythrocytes were noted,but vasculitis was absent.The diagnosis of rheumatoid neutrophilic dermatitis was established based on medical history,clinical features,laboratory findings and histopathological manifestation.