NEJM临床图片疣状地方性象皮肿
摘自6月26日刊《新英格兰医学杂志》：
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49岁女，患有病态性肥胖和高血压，因双脚出现广泛性红斑样泪滴状溃疡求诊。既往慢性静脉淤滞及淋巴水肿8年。查体发现下肢慢性坠积性水肿，伴角化过度及乳头状斑块，表面附着松散的痂皮及鹅卵石样结节。这些病变累及大腿内侧，近膝盖处可见包括水肿在内的急性病变，左侧小腿以下的前面可见泪滴状表面溃疡。双下肢静脉多谱勒仪检查未发现深静脉血栓形成。这种由慢性静脉淤滞所致的病理改变亦称为疣状地方性象皮肿。患者通常无丝虫病病史，但可有淋巴管炎、蜂窝织炎、硬皮病和肥胖的病史。本例患者接受了创口护理及短程抗生素治疗。2天后，水肿和热感消失。
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A49-year-oldwomanwithmorbidobesityandhypertensionpresentedwithextensiveareasofrednessandweepingsoresonherlegs.Shehadan8-yearhistoryofchronicvenousstasisandlymphedema.Thephysicalexaminationofthelowerextremitiesshowedchronicchangesofdependentedemawithhyperkeratosis,papillomatousplaques,andlooselyadherentcrustandcobblestone-likenodulesthatextendedtothethigh(inset),alongwithmoreacutechangesthatincludederythemauptothekneewithaweepingsuperficialulcerontheanterioraspectoftheleftlegbelowthecalf.VenousDopplerstudiesofthelegsandfeetrevealednoevidenceofdeep-veinthrombosis.Thesechangesthatoccurasaresultofchronicvenousstasisareknownaselephantiasisnostrasverrucosa.Thereisoftennohistoryoffilariasis,butpatientsoftenhavelymphangitis,cellulitis,scleroderma,andobesity.Shewastreatedwithwoundcareandabriefcourseofantimicrobialtherapy.Theerythemaandwarmthimprovedafter2days.
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