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紋身會導致皮膚出現肉芽腫癥狀

本欄目典型病例采集自國外先進的醫學期刊,采集、翻譯、編輯均為北翱醫藥所有。轉載請注明來源。
(From
www.thelancet.com Vol 382 July 20,2013)


一位來自紐約的37歲男子發現在紋身12年的部位出現紅色斑點,醫生開始懷疑是由于性傳播疾病導致的這種癥狀,通過顯微鏡的觀察使他們找到了真正的病因。

這位來到位于紐約第一大道醫院的患者,是因為紋身處出現了紅色斑點,這些紅色斑點已經從右腿上12年前紋身處開始蔓延。最近這兩周,病人飽受疼痛和腳踝腫脹的折磨,同時,兩條腿的肌肉都會疼,并伴有發燒,感覺疲憊,夜間大量流汗等癥狀。JoseRodolfoGuerra領導的團隊通過全身檢查發現兩個腫脹的腳踝和皮膚都變紅了,尤其是跟腱處,并且接觸跟腱時病人會感到疼痛。病人腳踝的活動受到嚴重的限制。在病人右腿的紋身處,醫生還發現粉紅色的斑點處且有白色的組織。

醫生分析了病人的血液樣本后,發現病人患有貧血,血液中循環的氧轉移血紅蛋白稀少。通過明顯的肺部X射線圖發現病人可能患有反應性關節炎,這是一種炎癥性關節的變化,是由于感染某種病毒后機體免疫系統的反應。但是,沒有發現病人受到何種感染。通常情況下,感染衣原體或淋病會導致反應性關節炎,兩者都是性傳播的,但是病人沒有明顯的感染癥狀,也沒有多位性伴侶,同時,實驗室的檢測結果是陰性,也沒有發現其他風濕性疾病的跡象,最終,醫生從紋身表皮處穿孔得到微量樣品,在顯微鏡下觀察后,發現皮膚上出現非正常的細胞密集群。所謂的肉芽腫是肉狀瘤病表象或結締組織的肉狀瘤病。

通常小節點出現在不定的器官,尤其是肺部。隨后的X射線和CT檢查也顯示該病人出現了這種病癥。該病人患有一種特殊的肉芽腫病,醫生診斷其是急性病,他腫脹的關節和疼痛感是所謂的洛夫格倫綜合征。引起肉芽腫病的原因至今尚不明確,預后的變化范圍在自愈以及慢性或偶然的惡化之間。

總的來說,盡管年輕病人出現這些癥狀時很可能會自愈,但是肉狀瘤病的病因還未知,醫生只能先治療這些癥狀。醫生給病人用可的松制劑可以在幾天內緩解這些癥狀,并且癥狀不會反復,不需要更多的可的松。JoseRodolfoGuerra和之前有類似病情的病人也發現了由于紋身導致的皮膚的變化。從1955年的第一個病例到現在已經有相似的32個科學報道,尤其是紋身的紅,黑或藍黑的處,在幾個月后就會出現肉瘤狀節點。關于人體對紋身的這種反應的原因,醫生只能推測皮膚上免疫系統對顏色的持續的對抗導致了肉狀瘤病的爆發。

英文稿:Granulomatous tattoo reaction in a young man

Fromwww.thelancet.com Vol 382 July 20, 2013

Under histwelve year oldtattooa 37 year old man from New Yorknoticedrednodules.At the hospital,the doctorssuspecta sexually transmitted diseasethat causedthis symptoms.Only a lookthrough the microscopebrings themon the right track.

Rednoduleslet amangototheMetropolitanHospital Centerat New York'sFirst Avenue.They spreadamongan already12 yearoldtattoo onhis rightleg.Since twoweeks he isplagued bypain andswollenankles he sayshis doctors.Meanwhile,in both legs the muscles hurt,hehas fever,feels tired andill and sweats profuselyat night.On examinationthedoctorsaroundJoseRodolfoGuerradiscoveredswollenankles onbothlegsandthe skin isreddenedparticularlyontheAchilles tendon, wherethe patient reactswithpain on contact.Hecan hardlyturnhisfootandtheankle motionissignificantly limited.Under thetattooon hisright leg, the doctorsrecognizethenodulesdescribedby the patientwhichwerepinkwith whitelining.

The doctorsanalyze theblood ofthepatientin the laboratoryandhope tofind a clueto the causes ofcomplaints.They noticedthattheirpatientsuffers fromanemia-too littleoftheoxygentransporterhemoglobin circulates in the blood. Along witha conspicuousX-rayimageof the lungs, the findings led to an assumption: the patientmight be suffering froma reactivearthritis which is an inflammatoryjointchange,whichresults as a body'simmune system reaction afteran infection.However, there wasno evidence ofinfection inthe man.Typically,infection withchlamydia orgonorrhealeadstoreactivearthritis,both of whicharesexually transmitted.But themanhad notypicalsymptoms of infection and did nothave sexwith multiple partners.Also, thelab testsremainednegative.Laboratory tests did also not showevidence ofother rheumaticdiseases.Finally, thedoctorspunch asmallsamplefrom thetattooed skinandexamineit undera microscope.

What theysawbroughtthemon the right track:Dark spotsappear in the tissueandunusuallydensecluster of cellswerein the skin.Socalledgranulomasare a sign of sarcoidosisorsarcoidosisdiseaseofthe connective tissue.Typically the small nodulesappear in differentorgans,mostofteninthe lungs.This is what happenedto the New Yorkpatient, whichan x-rayandaCT scanlatershowed.Thepatientsuffered froma specialformof sarcoidosisandthe doctors diagnosed:the personisacutelyillandhis jointsareswollenand painful, what is called “L?fgrensyndrome”.The causeof sarcoidosisisnotknownuntil today.The prognosisranges from aspontaneous self-healingtoachronicorepisodicdeterioration.

Overall, though,especially youngerpatientshave a good chancethat the symptomswill disappearby itself.Since the cause ofsarcoidosisis unknown,doctors canonly treat thesymptoms.Theygavetheirpatientacortisonepreparationthatrelievedthesymptomswithin a few days.Sincethistreatmentinthe hospital, the patientwasasymptomaticanddid notneed furthercortisone.The actualreportfromJoseRodolfoGuerra andhis colleaguesas well asearlierdescriptions ofpatients withsarcoidosisalsonoticedskinchangesdue totattoos.Since the firstcase reportin 1955there wereatotal of 32similarscientificpublications.Especially inred, black orblue-blackareasofthetattoos,sarcoidosisnodulesappearmonthsor decadeslater.About whatcausesthis reactionof the body tothetattoos, thephysicianscanonly speculate.They assumethat theongoing confrontationofthe colorwith the immune systemin the skincanletbreakoutthesarcoidosis.


 
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