PDF(Pubmed)
Abstract：
Acute cutaneous necrosis is a rare presentation of polyarteritis nodosa (PAN). In this study, we report a presentation with symmetrical cutaneous necrosis of the lower limbs, which ascended upward at a rapid rate. A 47-year-old man presented with a fever of one day and pain in the feet for six days. He had no history of claudication. Upon examination, he was febrile, and subtle bluish discoloration was observed on the sole of his foot. There was a bilateral stocking-type paresthesia up to the ankle joint. His blood pressure on admission was 210/120 mmHg. Eight hours later, the pain subsided, but a left-sided foot drop was noted along with the paresthesia extending up both feet to approximately 10 cm above the medial malleolus. The feet turned black, and dark discoloration spread rapidly upward over the next 16 hours, and the skin became necrosed. A clinical diagnosis of vasculitis was established, and the patient received IV methylprednisolone at a daily dosage of 1 g for three days, effectively stopping the advancement of necrosis. This was followed by treatment with IV cyclophosphamide. A conclusive diagnosis of PAN was made, and the patient underwent wound debridement. After three months of physiotherapy, a successful skin graft was performed. Prompt identification of the underlying etiology is crucial to prevent the advancement of necrosis and save the limbs. When vasculitis is suspected, ruling out infectious causes is essential before starting early immunosuppressive treatment.
摘要：
急性皮肤坏死是结节性多动脉炎（PAN）的罕见表现。在这项研究中,我们报告了一个对称的下肢皮肤坏死，迅速上升。一名47岁的男子发烧一天，脚痛六天。他没有跛行病史。经检查,他发烧了,在他的脚底上观察到微妙的蓝色变色。踝关节有双侧长袜型感觉异常。入院时的血压为210/120mmHg。八个小时后,疼痛消退了，但是注意到左侧足下垂，感觉异常向上延伸到双脚到内踝上方约10厘米。脚变成黑色，在接下来的16个小时里，深色变色迅速向上蔓延，皮肤坏死了.建立了血管炎的临床诊断，患者接受静脉注射甲基强的松龙，每日剂量为1克，持续三天，有效阻止坏死的进展。随后用IV环磷酰胺处理。对PAN做出了决定性的诊断，患者接受了伤口清创术。经过三个月的物理治疗,成功进行了皮肤移植。及时识别潜在的病因对于防止坏死的发展和挽救四肢至关重要。当怀疑血管炎时，在开始早期免疫抑制治疗之前，排除感染原因是必不可少的。
