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患儿男,5岁。躯干、四肢皮疹伴瘙痒1周。7个月前,因患“急性B淋巴细胞白血病”行异基因造血干细胞移植术,术后发生两次急性移植物抗宿主病,临床表现为绿豆大鲜红色丘疹,压之退色,疹间皮肤正常,曾予糖皮质激素或免疫抑制剂治疗,丘疹可消退。皮肤科情况:面、颈、躯干及四肢伸侧可见散在分布大小不一的圆形或椭圆形干燥性红斑,上覆白色鳞屑,指/趾甲无受累,Auspitz’s征阴性。皮损组织病理示:表皮不规则增厚,浆痂形成,灶性海绵水肿,灶性基底细胞液化,表皮内可见个别坏死角质形成细胞,真皮浅中层血管周围可见稀疏的单一核细胞浸润。诊断:银屑病样表现的慢性移植物抗宿主病。
Children male, 5 years old. Trunk, limbs rash with itching 1 week. Seven months ago, due to suffering from “acute lymphoblastic leukemia,” allogeneic hematopoietic stem cell transplantation, postoperative acute graft-versus-host disease twice, the clinical manifestations of mung bean red papules, pressure of the fade, rash Normal skin, had been treated with glucocorticoids or immunosuppressive agents, pimples subsided. Dermatology: face, neck, trunk and limb extensor can be seen scattered in different sizes of round or oval dry erythema, covered with white scales, nails without involvement, Auspitz’s sign negative. Histopathological examination showed that there were irregular thickening of the epidermis, formation of plasma callus, edema of focal sponge and liquefaction of focal basal cells. Individual necrotic keratinocytes were found in the epidermis, and sparse mononuclear cells infiltrated around the superficial dermis. Diagnosis: Psoriasis-like manifestation of chronic graft versus host disease.