【摘要】 患者男,32岁。右小腿疼痛1个月,截肢术后创面溃疡伴高热半月。1个月前无明显诱因出现双侧小腿后区疼痛,血管造影示双下肢血管炎性改变、右胫后动脉血栓形成、血管闭塞。先后行右下肢血管介入术、右小腿骨筋膜室切开减压术、右股骨髁上截肢术,术后持续高热,切口处溃疡形成,周围皮肤红肿,大量渗液。经头孢类抗感染药物联合甲强龙80mg/d及VSD清创治疗无效。组织病理检查示:(1)感染性肉芽组织;(2)白细胞碎裂性血管炎。皮肤科会诊拟诊坏疽性脓皮病,在足量敏感头孢类抗生素抗感染治疗的同时,大剂量甲强龙联合IVIG,成功控制病情。更多还原

【Abstract】 A 32-year old male patient,the right leg pain for 1 months,amputation wound ulcers with high fever. No obvious incentive before the occurrence of bilateral lower leg pain,lower extremity angiography found both lower extremity vasculitis changes,right posterior tibial artery thrombosis,vascular occlusion,followed by right lower limb vascular intervention,Right leg of the fascia room incision decompression and even the right femoral condylar amputation. After operation,the patients got high fever and ulcer atthe incision,with the surrounding skin swelling and a large number of exudate. The combined treatment including cephalosporin,methylprednisolone( 80mg/d) and VSD debridement treatment proved invalid. Histopathological examination showed:(1)infectious granulation tissue;(2)leukocyte fragmentation vasculitis. Dermatological consultation diagnosis took gangrenous pyoderma disease into consideration. Then,beside the treatment of cephalosporin to act as anti-infection,high-dose methylprednisolone combined with IVIG was prescribed,which successfully control the disease.更多还原