火焰及含重金属热液致大面积烧伤创面继发皮肤溃疡1例

董鸿斐; 黄茜; 吴继友; 李先慧

doi:10.3760/cma.j.cn501120-20211115-00386

火焰及含重金属热液致大面积烧伤创面继发皮肤溃疡1例

doi: 10.3760/cma.j.cn501120-20211115-00386

西部战区总医院烧伤整形外科，成都　　610083

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通讯作者:
李先慧，Email：tommy517@126.com

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出版历程
- 收稿日期: 2021-11-15

A case of skin ulcers secondary to extensive burns caused by flame and heavy metal-containing hydrothermal fluids

Department of Burn Plastic Surgery, General Hospital of Western Theater Command, Chengdu 610083, China

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Corresponding author: Li Xianhui, Email: tommy517@126.com

摘要

摘要: 2020年5月13日，西部战区总医院收治1例因火焰及含重金属热液致大面积烧伤的56岁男性患者，入院后经分次清创、扩创、植皮、抗休克、抗感染、补液、创面换药等治疗后，大部分烧伤创面痊愈，但在治疗中后期，患者烧伤创面逐渐出现反复皮肤破溃及炎症，排除创面因物理、细菌感染等致病后，最终依靠组织病理活体组织检查及IgG4组织液浓度测定明确诊断为IgG4相关性皮肤疾病，给予激素治疗后病情得以改善。这提示大面积烧伤可能会导致自身免疫性皮肤疾病的发生，对于这类疾病的诊断，需要综合临床表现、血清学检查、组织病理活体组织检查等避免诊断陷阱从而得出正确结论。
- 烧伤，化学 /
- 溃疡 /
- 获得性自身免疫病 /
- IgG4相关性皮肤疾病 /
- 创面修复
Abstract: On May 13, 2020, a 56-year-old man with extensive burns caused by flames and heavy metal-containing hydrothermal fluids was admitted to the General Hospital of Western Theater Command. After being admitted to the hospital, most of the burn wounds healed after treatments such as debridement, expansion, skin grafting, anti-shock, anti-infection, fluid replacement, and wound dressing change, etc. However, in the middle and late stages of treatment, the patient's burn wounds gradually showed repeated skin ulceration and inflammation. After excluding the cause of physical, bacterial infection and others, IgG4-related skin diseases was finally diagnosed by histopathological examination of tissue biopsy and concentration measurement of IgG4 in interstitial fluid, and the condition was improved after hormone treatment. This suggests that extensive burns may lead to the occurrence of autoimmune skin diseases. For the diagnosis of such diseases, it is necessary to combine clinical manifestations, serological examinations, and histopathological biopsy, etc. to avoid diagnostic pitfalls and draw correct conclusions.
- Burns, chemical /
- Ulcer /
- Acquired autoimmune diseases /
- IgG4-related skin diseases /
- Wound repair
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1 患者因火焰及含重金属热液致大面积烧伤继发溃疡创面情况。1A.溃疡表面最初呈水疱样改变；1B.水疱破裂后，溃疡表面增生且呈隆起样改变

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2 患者因火焰及含重金属热液致大面积烧伤继发溃疡创面与其他急性烧伤愈合创面情况对比。2A、2B、2C.分别为患者腹部、背部溃疡创面及其他急性烧伤愈合创面，图2A、2B中胶原纤维形成类似“席纹样”或“鸟眼样”外观苏木精-伊红×200；2D、2E、2F.分别为患者腹部、背部溃疡创面及其他急性烧伤愈合创面，图2D、2E中胶原纤维形成类似“席纹样”或“鸟眼样”外观 Masson×200；2G、2H、2I.分别为病例患者腹部、背部溃疡创面及其他急性烧伤愈合创面，图2G、2H中阳性细胞数明显多于图2I 辣根过氧化物酶-苏木精×630

注：图2A、2B、2D、2E中黑色虚线圈定区域为胶原纤维；红色箭头指示创面内毛细血管；IgG4阳性细胞呈棕褐色，细胞核阳性染色为蓝色

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3 患者因火焰及含重金属热液致大面积烧伤继发溃疡创面局部应用低浓度地塞米松治疗前后的创面变化。3A.溃疡创面治疗前；3B.溃疡创面治疗1周后改善

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