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例l:女,24岁,因面颈部、两手背、前臂、足背反复红斑、大小疱疹,并继发皮肤粗糙,呈褐黑色,周围有晕状红斑1年余,于1990年7月18日求诊。4年前起常头昏,失眠,乏力,继后时有恶心呕吐和咽梗感,厌食,腹泻,为不消化糊状腐臭便,日约3～5次。曾各地就诊,仅短暂好转,于3年前夏秋间又复发,且精神焦虑和忧郁更迭,腹泻和便秘交替。但皮损轻微,仅右上额及双手背偶起红斑或小丘疹,尤以日晒后明显,肤轻松软膏涂布可消退,但易复发。1年前皮损症状明显,右上额部水肿性红斑渐向眉、鼻部、颏部扩散,继之颈下三角区、两手背、前臂、足背、胫踝前均累及,以红斑、大小疱疹为主,色自鲜红渐转黯红。近2月来呈褐黑色,且皮肤粗糙、角化,周沿有红晕斑。神萎,步履困难,自觉束足感,双手有不自主阵发性轻颤,厌食,咽梗感等,外院曾以胃肠炎、肝炎、皮肤白血病、系统性红斑狼疮、药疹等诊治。以往体健。但自幼偏食,除鱼食外对肉、蛋、蔬菜瓜果类均拒之。体检,团圆脸,神萎,步态蹒跚,颈软,腱反射亢进。神经系统正常,心肺正常,腹软,肝肋下刚及,软,无扪痛,脾未及,肠鸣音稍亢。皮肤科检查:
Example l: Female, 24 years old, due to face and neck, hands back, forearm, foot back repeated erythema, herpes size, and secondary skin roughness, brownish black, around the halo erythema more than 1 year, in July 1990 18 days for treatment. 4 years ago, often dizziness, insomnia, fatigue, followed by nausea and vomiting and pharyngeal infarction, anorexia, diarrhea, digestibility paste is not digestible, about 3 to 5 times. Visited all over the country, only a brief turnaround, recurrence in summer and fall three years ago, and the spirit of anxiety and melancholy change, alternating diarrhea and constipation. However, minor skin lesions, only the amount of the right upper hand and his back with occasional erythema or papules, especially after sun exposure, skin easily ointment coating can be subsided, but easy to relapse. 1 year ago, the symptoms of the skin lesions were obvious. The edematous erythema on the upper right forehead gradually spread to the eyebrow, the nose and the chin spread, followed by the neck under the triangle area, both hands back, forearm, dorsal foot, anterior tibia and ankle, erythema, Herpes-based, color red gradually dark red. Nearly 2 months was brown, and the skin rough, keratosis, there are weeks around the red halo spots. Atrophy, walking difficulties, constrictive feeling, his hands involuntary paroxysmal tremors, anorexia, pharynx and stem flu, outside the hospital had gastroenteritis, hepatitis, cutaneous leukemia, systemic lupus erythematosus, drug eruption and other treatment. Past physical health. However, since partial eclipse, in addition to fish on the meat, eggs, vegetables and fruits are rejected. Physical examination, reunion face, wilted, staggering gait, neck soft, tendon hyperreflexia. Nervous system is normal, normal heart and lung, abdominal soft, just under the ribs, soft, no pain in the tuberculosis, spleen and bowel sounds a little hyperactivity. Dermatological examination: