每日一题_2024.10.11

A 19-year-old man with a history of mild acne vulgaris presented with a 10-day history of rapidly worsening acne, along with fever, muscle aches, and knee pain. His temperature was 38.5°C. On physical examination, diffuse papulonodular and pustular lesions with areas of overlying crusting were noted across the forehead, nose, cheeks, and chin. There were similar lesions on the neck, shoulders, chest, back, and thighs. Laboratory studies were notable for neutrophilic leukocytosis and an elevated erythrocyte sedimentation rate and C-reactive protein level. A culture of a skin swab grew only Cutibacterium acnes. Histopathological examination of a skin-biopsy specimen taken from behind the left ear showed suppurative folliculitis with adjacent dermal edema. What is the most likely diagnosis?

一名19岁男性，有轻度寻常性痤疮病史，有10天快速恶化的痤疮病史，同时伴有发烧、肌肉疼痛和膝盖疼痛。他的体温是38.5°C。体格检查时，前额、鼻子、脸颊和下巴可见弥漫性丘疹和脓疱性病变，并有覆盖的硬壳。颈部、肩部、胸部、背部和大腿也有类似的病变。实验室研究显示嗜中性粒细胞增多，红细胞沉降率和c反应蛋白水平升高。皮肤拭子的培养只生长出痤疮表皮杆菌。左耳后皮肤活检标本的组织病理学检查显示化脓性毛囊炎伴邻近真皮水肿。最可能的诊断是什么?

A. Acne fulminans暴发性痤疮

B. Acute febrile neutrophilic dermatosis急性发热性中性粒细胞皮肤病

C. Hidradenitis suppurativa化脓性汗腺炎

D. Pustular psoriasis脓疱性牛皮癣

E. Rosacea fulminans暴发性红斑痤疮

答案解析：

暴发性痤疮是炎症性痤疮的一种急性、严重变型，可能伴有全身症状，如发热、肌痛、关节痛，甚至溶骨性骨病变。这种情况可能是由异维甲酸治疗引起的，也可能是自发发生的，就像本病例一样。治疗包括口服糖皮质激素、异维甲酸和局部抗菌剂。

正确答案：A