葡萄球菌烫伤样皮肤综合征临床病例

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“葡萄球菌烫伤样皮肤综合征(staphylococcal scalded skin syndrome, SSSS)是是发生在新生儿的一种严重的急性泛发性剥脱型脓疱病。这种疾病是由金黄色葡萄球菌产生的一种表皮剥脱毒素引起的，该毒素裂解表皮颗粒层的桥粒芯糖蛋白-1，导致表面脓疱疮形成。鉴别诊断是按中毒性表皮坏死松解症（TEN或Lyell综合征）的病状进行的。TEN主要是药物引起，包括磺胺类、抗痉挛药、抗生素等。为了说明鉴别诊断的困难，我们引用我们对一名一岁女孩的临床观察。病情较为严重的女孩一入院就送入抢救室去，诊断为Lyell综合征。入院时，观察到广泛的皮肤病变，即多个松弛性水疱和表皮松解。同时，粘膜没有受到影响。女孩被诊断为葡萄球菌烫伤样皮肤综合征。因此，SSSS和TEN的鉴别诊断是困难的。诊断时应考虑病史、临床表现，特别注意黏膜病变。

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作者简介

Irina R. Milyavskaya

St. Petersburg State Pediatric Medical University

Email: imilyavskaya@yandex.ru

MD, PhD, Associate Professor Department of Dermatovenerology

俄罗斯联邦, Saint Petersburg

Maria O. Revnova

St. Petersburg State Pediatric Medical University

Email: revnoff@mail.ru

MD, PhD, Dr. Med. Sci., Professor, Head of the A.F. Tur Department of Pediatrics

俄罗斯联邦, Saint Petersburg

Larisa M. Leina

St. Petersburg State Pediatric Medical University

Email: larisa.leina@mail.ru

MD, PhD, Associate Professor Department of Dermatovenerology

俄罗斯联邦, Saint Petersburg

Evgeny Yu. Felker

St. Petersburg State Pediatric Medical University

Email: felkeru@gmail.com

MD, PhD, Head of the Department of Anesthesiology and Intensive Care

俄罗斯联邦, Saint Petersburg

Olga K. Mineeva

St. Petersburg State Pediatric Medical University

Email: o-mine@ya.ru

Dermatovenereologist

俄罗斯联邦, Saint Petersburg

Elena S. Bolshakova

St. Petersburg State Pediatric Medical University

编辑信件的主要联系方式.
Email: 1kozgpmu@gmail.com

Head of Dermatovenerology Department

俄罗斯联邦, Saint Petersburg

参考

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2. 图.1. 葡萄球菌性烫伤样皮肤综合征，口腔周围皮肤损伤，呈红斑、表层脱皮和裂纹 Fig. 1. Staphylococcal scalded skin syndrome, skin lesions on the face around the mouth, in the form of erythema, superficial peeling and cracks

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3. 图.2. 葡萄球菌灼伤皮肤综合征，水泡破后的糜烂。像受II度大面积热灼 伤一样的“烫伤”皮肤 Fig. 2. Staphylococcal scalded skin syndrome, erosion at the place of the opened bubble, which reminds the II degree burn

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4. 图.3. 葡萄球菌灼伤皮肤综合征， “顿挫”形式，表现为轻微红斑和皮肤干燥，角质层表面脱落 Fig. 3. Staphylococcal scalded skin syndrome, abortive form, in the form of slight erythema and dry skin, superficial detachment of the stratum corneum

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5. 图.4. Lyell综合征，广泛的皮肤损伤呈弥漫性红斑，伴有多处严重糜烂。口腔粘膜有病变，在嘴唇上、嘴角处有出血性结痂 Fig. 4. Lyell’s syndrome, an extensive skin lesion in the form of diffuse erythema, with multiple deep erosions. There are a lesion in the oral mucosa, in the form of hemorrhagic crusts on the lips, in the corners of the mouth

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6. 图.5. Lyell综合征，皮肤、口腔、鼻和结膜的粘膜弥漫性病变。红斑以广泛的汇合糜烂为代表 Fig. 5. Lyell’s syndrome, diffuse lesions of the skin, mucous membranes of the mouth, nose and conjunctiva. Rashes are represented by extensive confluent erosions

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7. 图.6. 葡萄球菌性烫伤样皮肤综合征患者。皮肤上可看到类似于二度烧伤的广泛糜烂。“面具”似的面部 Fig. 6. Patient with staphylococcal scalded skin syndrome. Extensive erosions resembling a II degree burn are noted on the skin. The mask-like face

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8. 图.7. 葡萄球菌灼伤皮肤综合征患者在治疗第五天。糜烂的快速上皮化 Fig. 7. Patient with staphylococcal scalded skin syndrome on the 5th day of treatment. Rapid epithelialization of erosions

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