PDF(Pubmed)
Abstract：
Puffy hand syndrome occurs in addicts who have injected drugs either intravenously, intradermally, or subcutaneously. It usually presents as bilateral reversible pitting edema of the hands; less frequently, it occurs unilaterally. The forearms and arms may also be affected. The onset of puffy hand syndrome can occur while the patient is still injecting drugs; however, it can initially appear several years after injection of the drug has been discontinued. Infection with hepatitis C is a common comorbidity. A 47-year-old man is described who had a 20-year history of injecting methylamphetamine only into his non-dominant left arm, forearm, and hand and experienced his second episode of unilateral puffy hand syndrome four years after discontinuing injecting the drug and three years after his initial episode; he also had hepatitis C infection. He presented with erythema and pitting edema of his left hand and forearm. Cellulitis was initially suspected, and he was admitted to the hospital for intravenous antibiotics; all cultures were negative for pathogens. The erythema and swelling resolved after five days of therapy. Puffy hand syndrome has been associated with various drugs; it has also been observed to occur in women during pregnancy and occasionally associated with acrocyanosis. The diagnosis is often not originally entertained by the clinician; the condition is often initially treated empirically as an infection. Serologic evaluation is typically negative for rheumatologic diseases, such as systemic lupus erythematosus and scleroderma, and cultures of the skin and blood are usually negative for pathogens. Radiologic assessment (such as roentgenograms, ultrasound to rule out venous thrombosis, computed tomography, magnetic resonance imaging, venogram, and lymphangiogram) may be performed, to exclude other conditions. Skin biopsy of the affected edematous hand occasionally demonstrates granulomatous inflammation and foreign bodies (suggestive of starch or injection additives) in the dermis. The edema for some of the patients with puffy hand syndrome was successfully treated with daily bandaging with compression stockings. The pathogenesis of puffy hand syndrome is considered to be multifactorial: damage to the veins, injury to the lymphatic system, and direct toxicity of the injectable drugs to the vascular structures.
摘要：
浮肿的手综合征发生在静脉注射药物的吸毒者中，皮内,或者皮下.通常表现为双侧可逆性手部凹陷性水肿；频率较低，它是单方面发生的。前臂和手臂也可能受到影响。当患者仍在注射药物时，可以发生浮肿的手综合征;然而，它最初可能出现在药物注射停止后几年。丙型肝炎感染是一种常见的合并症。据描述，一名47岁的男子有20年的历史，他只向他的非优势左臂注射甲基苯丙胺，前臂,在停止注射药物四年后和初次发作三年后，他经历了第二次单侧浮肿手综合征；他还感染了丙型肝炎。他的左手和前臂出现红斑和凹陷性水肿。最初怀疑蜂窝织炎,他因静脉注射抗生素入院；所有培养物均为病原体阴性。治疗五天后红斑和肿胀消退。浮肿的手综合征与各种药物有关；也观察到它发生在怀孕期间的妇女中，偶尔会与肢端紫癜有关。该诊断通常最初不被临床医生所接受;该病症通常最初根据经验被视为感染。血清学评估通常对风湿病呈阴性，如系统性红斑狼疮和硬皮病，皮肤和血液的培养物通常对病原体呈阴性。放射学评估(如X线照片，超声排除静脉血栓,计算机断层扫描,磁共振成像，静脉造影,和淋巴管造影)可以进行，排除其他条件。受影响的水肿手的皮肤活检偶尔显示真皮中的肉芽肿性炎症和异物（提示淀粉或注射添加剂）。通过每天用压力袜包扎成功治疗了一些浮肿手综合征患者的水肿。浮肿手综合征的发病机制被认为是多因素的：静脉损伤，损伤淋巴系统,以及可注射药物对血管结构的直接毒性。
