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NEJM:多形性荨麻疹-案例报道

2016-08-05 chenshuo 译 MedSci原创

患者女性,3岁,因出现轻度瘙痒性荨麻疹样皮疹1天余而前往急诊科就诊。  据该患儿的父母称,该患儿以往没有药物过敏史或接触性过敏原病史。但在1周前,其感染了一种病毒性呼吸系统疾病。随后,患儿出现发热(38.8°C),发热的第二天患儿身上开始出现多处环形皮疹风团和瘀斑(如图A)。  发热的第三天,因患儿出现持续性的低热和手,脚及脸等部位肿胀而被送往急诊科。  常规体

患者女性,3岁,因出现轻度瘙痒性荨麻疹样皮疹1天余而前往急诊科就诊。

 
据该患儿的父母称,该患儿以往没有药物过敏史或接触性过敏原病史。但在1周前,其感染了一种病毒性呼吸系统疾病。随后,患儿出现发热(38.8°C),发热的第二天患儿身上开始出现多处环形皮疹风团和瘀斑(如图A)。

发热的第三天,因患儿出现持续性的低热和手、脚及脸等部位肿胀而被送往急诊科。 

常规体格检查发现,患儿肢端水肿和全身各处皮肤可见环形荨麻疹(如图B和C)。 

取笔做皮肤划痕症试验结果如图D所示。

另外,血常规、尿常规以及血清化学分析未见异常。 

最后,会诊医师诊断其为多形性荨麻疹,并使用苯海拉明药物进行对症治疗。

6天后,该患儿的皮疹现象逐渐消失,没有发现有进一步的后遗症表现。 

对于本案例中的患儿,由于其皮疹的性质特殊,再加上其先前的感染病史,其皮肤的临床表现,在临床上往往会被误诊为多形性红斑或其他严重的皮肤疾病。

原始出处:

Simon Kotlyar, M.D. Urticaria Multiforme.N Engl J Med 2016; 375:470August 4, 2016

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  2. [GetPortalCommentsPageByObjectIdResponse(id=2029045, encodeId=c61020290457d, content=<a href='/topic/show?id=27134324425' target=_blank style='color:#2F92EE;'>#多形性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43244, encryptionId=27134324425, topicName=多形性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Mon Jan 09 23:13:00 CST 2017, time=2017-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135228, encodeId=3c8e13522819, content=我也有过这种病,这病不是治标不治本的吗?, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=84831957339, createdName=1e12a3a3m60(暂无匿称), createdTime=Mon Sep 26 00:26:00 CST 2016, time=2016-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=131678, encodeId=53431316e896, content=你是医师?, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160920/IMG57E140E952D7F3406.jpg, createdBy=a6311954227, createdName=医术, createdTime=Tue Sep 20 22:16:00 CST 2016, time=2016-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113633, encodeId=c89911363338, content=好文章,赞!学习,探究。, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Thu Sep 08 12:14:00 CST 2016, time=2016-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355558, encodeId=33e41355558ac, content=<a href='/topic/show?id=0ff310302082' target=_blank style='color:#2F92EE;'>#麻疹#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103020, encryptionId=0ff310302082, topicName=麻疹)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sun Aug 07 02:13:00 CST 2016, time=2016-08-07, status=1, ipAttribution=)]
    2016-09-26 1e12a3a3m60(暂无匿称)

    我也有过这种病,这病不是治标不治本的吗?

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=2029045, encodeId=c61020290457d, content=<a href='/topic/show?id=27134324425' target=_blank style='color:#2F92EE;'>#多形性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43244, encryptionId=27134324425, topicName=多形性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Mon Jan 09 23:13:00 CST 2017, time=2017-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135228, encodeId=3c8e13522819, content=我也有过这种病,这病不是治标不治本的吗?, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=84831957339, createdName=1e12a3a3m60(暂无匿称), createdTime=Mon Sep 26 00:26:00 CST 2016, time=2016-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=131678, encodeId=53431316e896, content=你是医师?, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160920/IMG57E140E952D7F3406.jpg, createdBy=a6311954227, createdName=医术, createdTime=Tue Sep 20 22:16:00 CST 2016, time=2016-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113633, encodeId=c89911363338, content=好文章,赞!学习,探究。, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Thu Sep 08 12:14:00 CST 2016, time=2016-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355558, encodeId=33e41355558ac, content=<a href='/topic/show?id=0ff310302082' target=_blank style='color:#2F92EE;'>#麻疹#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103020, encryptionId=0ff310302082, topicName=麻疹)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sun Aug 07 02:13:00 CST 2016, time=2016-08-07, status=1, ipAttribution=)]
    2016-09-20 医术

    你是医师?

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=2029045, encodeId=c61020290457d, content=<a href='/topic/show?id=27134324425' target=_blank style='color:#2F92EE;'>#多形性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43244, encryptionId=27134324425, topicName=多形性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Mon Jan 09 23:13:00 CST 2017, time=2017-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135228, encodeId=3c8e13522819, content=我也有过这种病,这病不是治标不治本的吗?, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=84831957339, createdName=1e12a3a3m60(暂无匿称), createdTime=Mon Sep 26 00:26:00 CST 2016, time=2016-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=131678, encodeId=53431316e896, content=你是医师?, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160920/IMG57E140E952D7F3406.jpg, createdBy=a6311954227, createdName=医术, createdTime=Tue Sep 20 22:16:00 CST 2016, time=2016-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113633, encodeId=c89911363338, content=好文章,赞!学习,探究。, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Thu Sep 08 12:14:00 CST 2016, time=2016-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355558, encodeId=33e41355558ac, content=<a href='/topic/show?id=0ff310302082' target=_blank style='color:#2F92EE;'>#麻疹#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103020, encryptionId=0ff310302082, topicName=麻疹)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sun Aug 07 02:13:00 CST 2016, time=2016-08-07, status=1, ipAttribution=)]
    2016-09-08 ylzr123

    好文章,赞!学习,探究。

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=2029045, encodeId=c61020290457d, content=<a href='/topic/show?id=27134324425' target=_blank style='color:#2F92EE;'>#多形性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43244, encryptionId=27134324425, topicName=多形性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Mon Jan 09 23:13:00 CST 2017, time=2017-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135228, encodeId=3c8e13522819, content=我也有过这种病,这病不是治标不治本的吗?, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=84831957339, createdName=1e12a3a3m60(暂无匿称), createdTime=Mon Sep 26 00:26:00 CST 2016, time=2016-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=131678, encodeId=53431316e896, content=你是医师?, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160920/IMG57E140E952D7F3406.jpg, createdBy=a6311954227, createdName=医术, createdTime=Tue Sep 20 22:16:00 CST 2016, time=2016-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113633, encodeId=c89911363338, content=好文章,赞!学习,探究。, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Thu Sep 08 12:14:00 CST 2016, time=2016-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355558, encodeId=33e41355558ac, content=<a href='/topic/show?id=0ff310302082' target=_blank style='color:#2F92EE;'>#麻疹#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103020, encryptionId=0ff310302082, topicName=麻疹)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sun Aug 07 02:13:00 CST 2016, time=2016-08-07, status=1, ipAttribution=)]
    2016-08-07 zhaojie88

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