【摘要】 患者男，43岁，银屑病史10余年。患者10年前无明显诱因全身多处出现红色斑块，上覆白色厚屑。间断口服药物治疗，具体不详，效果不佳，皮疹反复。2年前无明显诱因皮疹泛发全身；全身大面积红色斑块，上覆银白色鳞屑；皮损累及头皮，尤以发际边缘为重，头发呈束状；未见黏膜损害，多个甲板可见“顶针状”凹陷。PASI评分：39.6。患者既往血脂增高20余年，糖尿病病史1年；10年前曾患“急性胰腺炎”,近2年油腻饮食后偶有发作。初步诊断为：(1)重度斑块状银屑病；(2)高脂血症；(3)2型糖尿病；(4)慢性胰腺炎。2021年12月开始规律应用阿达木单抗注射液，第16周PASI评分改善率达90%;2022年10月自行停药。2023年1月出现上腹部疼痛，查体发现上腹部肿物，行手术治疗，病理结果示：胰腺组织广泛纤维化及凝固性坏死，组织细胞增生。断端：纤维化变性坏死组织。进一步查干扰素γ释放试验阳性，胰腺组织抗酸染色结果阴性。在服用抗结核药物的基础上，继续给予阿达木单抗治疗。2023年10月复测结核菌素皮肤试验阴性，至今腹部未再出现不适。更多还原

【Abstract】 A 43-year-old male presented with 10-year history of psoriasis. Ten years ago, multiple erythema and silver-white scales appeared throughout his body without obvious cause. Intermittent oral medication was not effective, and could not prevent recurrence. Two years ago, the lesions recurred, presenting as the erythematous plaques and silver-white scales over the whole body. The scalp was affected, especially the hairline. The hair was visibly clusters, whereas the mucosa wasn′t involved. The minor pitting on the nail was also noticed. The psoriasis area and severity index(PASI) was 39.6. He has a twenty-year history of hyperlipidemia and a one-year history of diabetes, respectively. Ten years ago, he suffered from "acute pancreatitis", and for the last 2 years pancreatitis flared up occasionally after high-fat meal. The preliminary diagnosis were severe plaque psoriasis, hyperlipidemia, initial type 2 diabetes mellitus and chronic pancreatitis. Since December 2021, the use of adalimumab for 16 weeks has yielded remarkable improvement with a 90% decrease in PASI. However, he elected to stop the medication at his discretion in October 2022. The onset of upper abdominal pain led to the discovery of a palpable mass, which is identified as pancreatic necrosis through post-operational pathology in January 2023. Subsequently, interferon-gamma release assay was positive, in comparison to a negative acid-fast staining of pancreatic tissue. As such, the use of adalimumab was continued, and accompanied with simultaneous antituberculosis treatment. Eventually interferon-gamma release assay tended negative and there was no abdominal discomfort in October 2023.更多还原