不典型系统性红斑狼疮临床误诊分析
Clinical Misdiagnosis of Atypical Systemic Lupus Erythematosus
孙小媚 1刘微1
作者信息
- 1. 066000 河北 秦皇岛,北京大学第三医院秦皇岛医院风湿免疫科
- 折叠
摘要
目的 探讨不典型系统性红斑狼疮(SLE)的临床特点及误诊原因、防范措施.方法 回顾性分析2021年2 月—2023 年4 月收治的曾误诊的SLE 2 例的临床资料.结果 本文 1 例为 14 岁女患儿,以四肢皮疹为首发症状,遇冷后加重,后出现关节肿痛及发热症状,外院诊断为过敏性紫癜,予对症治疗效果欠佳.入我院后结合皮疹特点,经完善风湿免疫相关检查及皮肤组织活检确诊为SLE,给予糖皮质激素冲击治疗后好转出院.1 例为 46 岁女性患者,因睡眠障碍、颈部不适至外院骨科就诊,诊断为混合型颈椎病,伴有皮肤红斑、情绪低落、饮水呛咳、吞咽困难、生活不能自理.入我院后结合临床表现,经免疫学相关检查等诊断为SLE,予糖皮质激素和环磷酰胺冲击等治疗后症状好转出院,1 周后复诊状态良好.结论 SLE首发症状多种多样,且常起病隐匿,症状不典型,易误诊.加强对其不典型表现认识,熟知其发病特点及常见人群,仔细观察皮疹特点,详细询问病史,认真鉴别诊断,尽早完善血液学及免疫学检查,或可减少或避免SLE误诊误治.
Abstract
Objective To explore the clinical characteristics,causes of misdiagnosis and preventive measures of atypical systemic lupus erythematosus(SLE).Methods The clinical data of misdiagnosed SLE patients admitted to our hos-pital from February 2021 to April 2023 were retrospectively analyzed.Results A 14-year-old female presented with rash on the limbs as initial symptoms,which was worsened after exposure to cold,and later developed symptoms of joint swelling,pain,and fever.She was diagnosed with anaphylatic purpura in another hospital,and symptomatic treatment was far from sat-isfactory.After admission to our hospital,the rheumatism and immune-related examination and skin tissue biopsy were per-formed,SLE was confirmed.After receiving glucocorticoid shock therapy,the patient was discharged.Another 46-year-old fe-male patient was diagnosed with mixed cervical spondylosis in Department of Orthopedics of another hospital due to sleep disor-ders and neck discomfort,accompanied by skin erythema,low mood,coughing when drinking water,dysphagia,and inability to take care of themselves.After admission to our hospital,combined with the clinical manifestations and immunological exam-inations,the patient was diagnosed with SLE.After treatment with Glucocorticoid and Cyclophosphamide shock,the symptoms gradually improved and the patient was discharged from hospital.Conclusion The initial symptoms of SLE are varied,often insidious,atypical,and more likely to be misdiagnosed.Clinicians should strengthen their understanding of the atypical mani-festations of SLE,be familiar with the pathogenesis and common population of SLE,carefully observe the characteristics of the rash,inquire about the history in detail,carefully perform differential diagnosis,and perform the hematologic and immunologi-cal examination as soon as possible to reduce or avoid the misdiagnosis and mistreatment.
关键词
红斑狼疮,系统性/误诊/紫癜,过敏性/颈椎病/皮疹/抗核抗体/糖皮质激素/环磷酰胺Key words
Lupus erythematosus,systemic/Misdiagnosis/Purpura,anaphylatic/Cervical spondylosis/Rash/An-tinuclear antibody/Glucocorticoid/Cyclophosphamide引用本文复制引用
基金项目
秦皇岛市科学技术研究与发展计划(202201B018)
出版年
2024
国家科技期刊平台
NSTL
万方数据