小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 胫前结节
- 葡萄膜炎、眼红、视网膜结节或蜡滴样变
- 皮肤其他部位的结节
- 有麻木感的皮肤病变
其他诊断因素
- 关节疼痛
- 发热
- 腹泻、便秘、腹痛、便血
- 脾增大
- 视网膜上的粟粒状结节
危险因素
- 链球菌感染
- 结节病
- 结核
- 球孢子菌病
- 组织胞浆菌病
- 芽生菌病
- 布鲁菌病
- 白塞病
- 口服避孕药
- 磺胺类药物
- 碘化物和抗癫痫药
- 鹦鹉热
- 麻风病
- 炎症性肠病
- 妊娠
- 恶性肿瘤
诊断性检查
首要检查
- 全血细胞计数 (FBC）
- 抗链球菌溶血素O滴度
- 胸部 X 线检查
- 结核菌素皮肤试验、干扰素-γ 释放试验
需考虑的检查
- 血清 ACE 水平
- 皮肤病变活检
- 球孢子菌素皮肤试验
- 组织胞浆菌素皮肤试验
- 麻风菌素皮肤试验
- 芽生菌病血清学检测
- 布氏菌病血清学检查
- 鹦鹉热血清学检查
- 有症状关节的X 线检查
- 类风湿因子试验
- 耶尔森氏菌凝集试验
- 耶尔森氏菌粪便细菌培养
- 结肠镜检查
- 血清 IgD
- 使用深度达到皮下脂肪的钻孔活检，或采用切除活检
治疗流程
轻度至中重度症状
严重难治性症状
撰稿人
作者
Daniela Kroshinsky, MD, MPH
Associate Professor of Dermatology
Harvard Medical School
Director of Pediatric Dermatology
Director of Inpatient Dermatology
Massachusetts General Hospital
Boston
MA
利益声明
DK declares that she has no competing interests.
鸣谢
Dr Daniela Kroshinsky would like to gratefully acknowledge Dr Om P. Sharma, a previous contributor to this topic. Dr Kroshinsky would also like to thank Priyanka Vedak for her contribution to this topic. We would like to gratefully acknowledge the contribution of the late Elisabeth Higgins (Consultant Dermatologist, King’s College Hospital) for her peer review of this topic.
利益声明
OPS declared that he had no competing interests. PV declared that she had no competing interests. EH declared that she had no competing interests.
同行评议者
Robert T. Brodell, MD
Professor of Internal Medicine
Clinical Professor of Dermatopathology
Northeastern Ohio Universities College of Medicine
Warren
Associate Clinical Professor of Dermatology
Case Western Reserve University School of Medicine
Cleveland
OH
利益声明
RTB declares that he has no competing interests.
鉴别诊断
- Weber-Christian 病
- α-1 抗胰蛋白酶缺乏
- 结节性血管炎（硬结性红斑或 Bazin 病）
更多 鉴别诊断
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