每日一题_2023.01.23

A 37-year-old primigravid woman presented at 30 weeks’ gestation with a 4-month history of pruritic pustules on her torso, arms, and legs. On examination, there were papules, nodules, and follicular pustules with surrounding erythema, with no lesions on the palms and soles. A skin biopsy showed subepidermal pustules and perifollicular neutrophilic infiltration. Gram’s stain, periodic acid–Schiff stain, and Grocott methenamine silver stain were all negative. What is the most likely diagnosis?

一名 37 岁的初产妇在妊娠 30 周时就诊，她的躯干、手臂和腿部有 4 个月的瘙痒性脓疱病史。 查体有丘疹、结节、毛囊性脓疱，周围有红斑，手足未见皮损。 皮肤活检显示表皮下脓疱和毛囊周围中性粒细胞浸润。 革兰氏染色、高碘酸-希夫染色和 Grocott 乌洛托品银染均呈阴性。 什么是最可能的诊断？

A. Atopic eruption of pregnancy 妊娠特应性皮疹

B. Disseminated herpes zoster 播散性带状疱疹

C. Pemphigoid gestationis 妊娠类天疱疮

D. Polymorphic eruption of pregnancy 妊娠多形性皮疹

E. Secondary syphilis 二期梅毒

答案解析：

诊断为妊娠特应性皮疹。 妊娠特应性皮疹是最常见的妊娠皮肤病。 它包括湿疹、痒疹，以及本例中出现的瘙痒性毛囊炎。 由于患者瘙痒严重，医生开了环孢素和大剂量口服糖皮质激素。 在 2 周的随访中，病变已经减轻。

正确答案：A