CAJ | 학술논문

患者男，69岁。3年来，头、躯干和四肢出现散在红斑、毛囊性丘疹及痤疮样皮损(如粟丘疹、囊肿等)和脱发，病程中伴外周血嗜酸粒细胞增多。皮损组织病理检查示真皮内灶性慢性炎细胞浸润伴毛细血管增生，毛囊周围慢性炎细胞浸润伴血管增生，伴少许嗜酸粒细胞，考虑为毛囊炎，予抗组胺药和抗生素治疗后皮损炎症消退，瘙痒减轻。3个月后，枕部出现斑块伴脱发，组织病理检查示真皮内密集淋巴样细胞、嗜酸粒细胞浸润，毛囊周围大量淋巴样细胞浸润伴较多嗜酸粒细胞，可见不典型淋巴细胞，部分侵入毛囊，毛囊上皮黏液样变性。阿新蓝染色阳性。免疫组化染色：CD20、CD79a、EB病毒(EBV)、CD56、磷酸葡萄糖变位酶-1(PGM-1)、髓过氧化物酶(MPO)、CD7、抗角蛋白单克隆抗体AE1/AE3均阴性，异形细胞CD3、CD4、CD5、CD2、CD43、泛素羧基末端水解酶-L1 (UCHL-1)均阳性。T细胞受体基因重排结果为阴性。诊断：亲毛囊性蕈样肉芽肿。予光化学疗法(PUVA)联合阿维A治疗，仍有新发皮损，目前患者在随访中。
환자남，69세。3년래，두、구간화사지출현산재홍반、모낭성구진급좌창양피손(여속구진、낭종등)화탈발，병정중반외주혈기산립세포증다。피손조직병리검사시진피내조성만성염세포침윤반모세혈관증생，모낭주위만성염세포침윤반혈관증생，반소허기산립세포，고필위모낭염，여항조알약화항생소치료후피손염증소퇴，소양감경。3개월후，침부출현반괴반탈발，조직병리검사시진피내밀집림파양세포、기산립세포침윤，모낭주위대량림파양세포침윤반교다기산립세포，가견불전형림파세포，부분침입모낭，모낭상피점액양변성。아신람염색양성。면역조화염색：CD20、CD79a、EB병독(EBV)、CD56、린산포도당변위매-1(PGM-1)、수과양화물매(MPO)、CD7、항각단백단극륭항체AE1/AE3균음성，이형세포CD3、CD4、CD5、CD2、CD43、범소최기말단수해매-L1 (UCHL-1)균양성。T세포수체기인중배결과위음성。진단：친모낭성심양육아종。여광화학요법(PUVA)연합아유A치료，잉유신발피손，목전환자재수방중。
A 69-year-old man presented with a 3-year history of scattered erythematous patches, perifollicular papules, acneiform lesions (such as milia, cysts) on the head, trunk and limbs as well as alopecia and peripheral eosinophilia. Histopathological examination revealed chronic focal dermal and perifollicular inflammatory infiltration with vascular proliferation and presence of a small number of eosinophils. He was initially diagnosed with folliculitis, and treated with antihistamines and antibiotics. Thereafter, lesional inflammation and pruritus were attenuated. However, plaques and alopecia developed in the occipital area 3 months later. The second histopathology of biopsy specimens revealed a dense dermal infiltrate of lymphoid cells and eosinophils, perifollicular infiltrate with numerous lymphoid cells, eosinophils and atypical lymphocytes migrating into hair follicles. Alcian blue stain showed epidermal mucinosis in follicles. Immunohistochemical examination showed positive staining of atypical cells for CD3, CD4, CD5, CD2, CD43 and ubiquitin carboxyl-terminal esterase L1 (UCHL1), but negative staining for CD20, CD79a, Epstein-barr virus, CD56, phosphoglucomutase-1, myeloperoxidase, CD7, or AE1 and AE3 monoclonal anti-keratin antibodies. T-cell receptor gene rearrangement was undetected. He was diagnosed with folliculotropic mycosis fungoides. Novel skin lesions still emerged after treatment with photochemotherapy (PUVA) plus acitretin. Follow up of the patient still continued.