摘要
患者男性,37岁。长期从事站立性体力劳动,两踝关节内侧下方数个暗紫红色瘀斑,近1个月久站后皮损处疼痛。结合病史、病理切片及辅助检查,诊断为“假性Kaposi肉瘤”。经穿弹力袜、促进静脉回流、抗凝、改善循环后,双下肢皮损处无明显疼痛,皮损较前无明显扩大或增多。
假性Kaposi肉瘤,又称肢端血管性皮炎,是一种罕见的血管外科疾病。其发病机制是由于慢性静脉功能不全引起的组织缺氧或动静脉瘘导致血管内皮增生,改变静脉的流体静力和流体动力条件干扰局部的微循
患者 男,37岁。因“双下肢瘀斑10余年,久站后疼痛1个月余”于2021年9月24日入院。患者10余年前右踝关节内侧下方出现暗紫红色瘀斑,黄豆大小,边界清晰,表面光滑,触之柔软,无自觉症状,未诊治,皮损逐渐扩大融合至足背。4年前左踝关节以下部位也出现瘀斑,性质同前,完善皮肤活检,考虑“淤积性皮炎”,予以“羟苯磺酸钙胶囊、迈之灵片、多磺酸黏多糖乳膏、卤米松三氯生霜”等对症治疗,未见明显好转。1个月前久站后瘀斑处疼痛,可持续数小时,休息后可逐渐缓解,无瘙痒、关节痛、双下肢肿胀等。体格检查:双下肢静脉曲张,双踝关节以下可见数个大小不一、边界清楚暗紫色瘀斑,表面光滑,质较硬,有压痛,无红肿、破溃(

图1 相关图片资料 A:皮损形态;B:下肢血管彩超示股静脉少量反流
Figure 1 The relevant image data A: Appearance of skin lesions; B: Color Doppler ultrasound of the lower limb showing small amount of reflux in the femoral vein

图2 皮损组织病理学(HE×200) A:毛细血管增生,稀疏淋巴细胞浸润,无明显红细胞外溢(2017年);B:较多红细胞外溢及含铁血黄素沉积(2021年)
Figure 2 Histopathological observation of the skin lesions (HE×200) A: Capillary hyperplasia, sparse lymphocyte infiltration, and no obvious extravasation of the red blood cells (2017); B: Increased erythrocyte extravasation and hemosiderin deposition (2021)
结合病史、病理切片及辅助检查,诊断为"假性Kaposi肉瘤"。入院后建议患者避免久站,给予穿弹力袜,口服迈之灵片促进静脉回流、利伐沙班抗凝、银杏酮酯滴丸改善循环,及外用多磺酸黏多糖乳膏对症处理。4个月后随访患者,自行停用利伐沙班,长期口服迈之灵片及银杏酮酯滴丸,白天穿弹力袜,夜间抬高双下肢,双下肢皮损处无明显疼痛,皮损较前无明显扩大或增多。
假性Kaposi肉瘤与慢性静脉功能不全(静脉曲张、静脉瓣功能不全、肢体瘫痪或无力、病态肥胖)、动静脉瘘(先天性血管畸形、人工造瘘)、血管相关手术、截肢假体使用不当及外伤等影响血管的因素相关(
假性Kaposis肉瘤早期主要表现为瘀斑,无特异性表现,容易漏诊、误诊,常就诊于皮肤科,因该病主要是由于动静脉畸形或慢性静脉功能不全所致,需引起血管外科医生的重视。2014年,Alshihry
假性Kaposi肉瘤在临床上主要分为两种类型:⑴ Stewart-Bluefarb 型,常伴有Klippel-Trenaunay-Weber综合征:与动静脉畸形(arteriovenous malformation,AVM)或获得性动静脉瘘(慢性肾功能衰竭造瘘或外伤)相关,其特点是鲜红斑痣、静脉曲张与静脉畸形以及受累四肢的软组织肥大组成的三联征,常在幼年发病,单侧多见,早期皮损病理切片显示真皮全层受累,还可见动静脉分流,晚期病变显示由结缔组织隔膜分隔的血管小叶增生、含铁血黄素沉积、红细胞外渗和纤维化。⑵ Mali型:由慢性静脉供血不足引起,临床较为常见,发病迟,双侧多见,以紫色斑疹开始,逐渐扩大形成柔软、无触痛的丘疹、结节和斑块,周围有典型的淤积性皮炎表
目前研究认为假性Kaposi肉瘤的发病机制是由于慢性静功能不全引起的组织缺氧或动静脉瘘导致血管内皮增生所致。Smiddy
假性Kaposi肉瘤尚无特异性治疗,可给予局部抗生素和皮质类固醇联合使
假性Kaposi肉瘤是一种罕见的血管外科疾病,主要由慢性静脉功能不全、动静脉瘘(先天性或人工造瘘)、外科手术(血管内介入或静脉移植)等所致,为双下肢伸面紫色斑块或结节,并可能形成溃疡及出血,目前该疾病无特异性治疗,临床需要早期完善皮损病理学检查及血管影像学检查尽早明确诊断及病因。
利益冲突
所有作者均声明不存在利益冲突。
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