钟娇娇?张静?张军民?鲁莎?马坚池

【摘要】蕈样肉芽肿（MF）的临床表现复杂多变，该文报道1例少见的体癣样MF。该例患者因躯干、四肢皮疹伴瘙痒3年余就诊。专科检查提示躯干、四肢散在暗红色斑片，部分斑片中央消退，边缘呈堤状隆起，表面覆少量白色鳞屑，躯干四肢见广泛色素沉着和色素减退。经组织病理检查、免疫组织化学检查和T细胞受体（TCR）基因重排检测，诊断为MF。予口服糖皮质激素、环孢素及外用糖皮质激素软膏治疗2个月后，皮疹消退。该例提示MF皮疹多样，常漏诊误诊，怀疑此病應多次行皮肤病理检查，并进行免疫组织化学检查和TCR基因重排检测。

【关键词】蕈样肉芽肿;体癣;环状红斑;组织病理;色素异常

Mycosis fungoides mimicking tinea corporis： one case report Zhong Jiaojiao， Zhang Jing， Zhang Junmin， Lu Sha， Ma Jianchi. Department of Dermatology， Sun Yat-sen Memorial Hospital of Sun Yat-sen University， Guangzhou 510120， China

Corresponding author， Zhang Jing， E-mail： zhangj0811@ 126. com

【Abstract】The clinical manifestations of mycosis fungoides are complex and variable. In this article， we reported one rare case of mycosis fungoides mimicking tinea corporis. The patient was admitted to our department because of rash and pruritus involved with the trunk and limbs for more than 3 years. Physical examination revealed the signs of extensive rash， characterized by annular erythematous scaly patches with raised borders， which was similar to tinea corporis. The patient was diagnosed with mycosis fungoides by skin histopathological examination， immunohistochemistry， and T cell receptor gene rearrangement. After two-month treatment of glucocorticoid， cyclosporine and topical drugs， the rash was significantly relieved. This case prompts that it is likely to miss the diagnosis and misdiagnose the mycosis fungoides due to diverse manifestations. The diagnosis should be confirmed by repeated skin pathological examination， immunohistochemical staining and T cell receptor gene rearrangement should be performed.

【Key words】Mycosis fungoides;Tinea corporis;Erythema annularis;Histopathology;

Pigmentation abnormality

蕈样肉芽肿（MF）是起源于记忆性辅助性T细胞的低度恶性皮肤T细胞淋巴瘤，约占所有原发性皮肤T细胞淋巴瘤的50%[1]。MF的临床表现复杂多变，与许多其他皮肤疾病临床表现相似，包括湿疹、毛囊炎、接触性皮炎和银屑病等[2]。现将我科收治的1例临床表现似体癣的MF报道如下，以提高临床医师对此病的认识。

病例资料

一、病史及体格检查

患者女，68岁。因躯干、四肢皮疹伴瘙痒3年余于2019年9月5日就诊。患者3年前无明显诱因于躯干、四肢出现散在暗红斑，感剧烈瘙痒，红斑渐发展成中央消退边缘隆起的环形，表面覆薄鳞屑，在外院多次诊断为“体癣”，口服伊曲康唑及外用抗真菌药物治疗无效。1年前曾于我科进行2次皮肤病理活组织检查（活检），病理表现分别提示“Sweets病”和“环状肉芽肿”，予口服糖皮质激素、免疫抑制剂治疗后红斑消退，消退后遗留色素沉着和色素减退斑。……