NEJM临床医学影像急性风湿热伴边

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ImagesinClinicalMedicineAcuteRheumaticFeverwithErythemaMarginatumMakotoSaito,ShujiHatakeyamaNEnglJMed;:DOI:10./NEJMicm

Apreviouslyhealthy36-year-oldmanpresentedwitha1-monthhistoryoffeverandpaininbothshouldersandknees,whichhadbeenprecededbyasorethroat2weeksbeforetheonsetoffever.Laboratorystudieswerenotableforawhite-cellcountof13,percubicmillimeter(85%neutrophils),aC-reactiveproteinlevelof26mgperdeciliter(referencevalue,≤0.3),andanantistreptolysinOtiterofIUpermilliliter(referencevalue,).Transthoracicechocardiographyrevealedmildaorticregurgitation.Hisfeverandarthralgiasabatedaftertheadministrationofanonsteroidalantiinflammatorydrug.Oneweeklater,painless,non-pruritic,redannularmaculesappearedontheupperlimbsandabdomen(PanelAshowstherightforearm;blackinkdotsindicatethediameterofonelesion10hoursbeforethetimethatthephotographwastaken).Therashmigratedwithinhoursandthenfadedoverthecourseofafewdayswhilenewlesionsappeared(Fig.S1intheSupplementaryAppendix,availableatNEJM.org).Skinbiopsyrevealedperivascularinfiltrationoflymphocytesandneutrophilsinthedermis(PanelB,hematoxylinandeosin).Acuterheumaticfeverwitherythemamarginatumwasdiagnosed.Erythemamarginatum,anevanescentnonpruriticmacularrash,isoneofthemajorJonescriteriaforthediagnosisofacuterheumaticfever.Thepatientbegantakingamoxicillinforsecondaryprophylaxisofrheumaticheartdisease.Therashdisappeared







































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