壞疽性膿皮症之病例報告

Pyoderma Gangrenosum: A Case Report and Discussion

劉晏孜(Yen-Tze Liu) ； 邱瑩明(Ying-Ming Chiu) ； 林益卿(I-Ching Lin)

《內科學誌》 23卷2期 (2012/04) Pp. 137-143

https://doi.org/10.6314/JIMT.2012.23(2).08

摘要

壞疽性膿皮症（pyoderma gangrenosum）是一種罕見的自體免疫疾病，常侵犯的部位以下肢脛骨前區為主，會造成潰瘍性的皮膚病灶，常與一些系統性疾病相關，例如發炎性腸病（inflammatory bowel disease）、免疫相關性之關節炎、血液腫瘤疾病、肝炎、或後天免疫缺乏症候群（AIDS）等等。本文報告一名29歲女性，因左下肢潰瘍性傷口就醫，由於傷口巨大且具壞死組織，疑似併細菌感染，於是入院治療。根據此病人本身有潰瘍性大腸炎病史，加上臨床皮膚病灶之特徵，暫定診斷為壞疽性膿皮症，後經皮膚切片之病理報告確診。住院期間主要使用免疫調節劑（Sulfasalazine）及類固醇治療，另以抗生素控制次發性感染，約三週後傷口逐漸好轉、病情改善出院。針對此類有潰瘍性皮膚病灶病人，除了懷疑是否為常見之細菌感染外，也應該詳細詢問病人過去病史及發病經過，以免錯失及延誤病人的診斷及治療。

關鍵字

壞疽性膿皮症 ； 潰瘍性結腸炎

並列摘要

Pyoderma gangrnosum is a rare autoimmune disease. It commonly occurs on the lower legs with preference for the pretibial area, causing ulcerative skin lesions. It is commonly associated with some systemic diseases, such as inflammatory bowel disease, rheumatoid arthritis, hematological disease, malignancy, hepatitis, and acquired immune deficiency syndrome (AIDS). Here, we present a 29-year-old woman who suffered from left leg ulcerative wounds with tissue necrosis. Considering her past history of ulcerative colitis and the characteristics of skin lesions, a tentative diagnosis of pyoderma gangrenosum was made. A skin biopsy later confirmed the diagnosis. After treatment with immunomodulator (Sulfasalazine) and steroids, and concurrent antibiotics for secondary infection, her wounds recovered 3 weeks later. The purpose of this article is to remind physicians of the importance of complete history taking in patients with such ulcerative wounds to avoid error or delay in diagnosis and treatment. (J Intern Med Taiwan 2012; 23: 137-143)

並列關鍵字

Pyoderma gangrenosum ； Ulcerative colitis