Text/Figure Yangcheng Evening News all-media reporter Zhang Hua
"Teacher, I have a special patient, I have never seen it, I can't handle it here, I want to transfer it to you." Receiving a phone call from Liu Jingye, chief physician of the Department of Dermatology of the Sixth People's Hospital of Panyu District, Professor Keluo Diqing of the East Hospital of the First Affiliated Hospital of Sun Yat-sen University was also very curious in his heart, what kind of patient made a chief physician helpless?
The whole abdomen is basically ulcerated
On July 6, 2021, this lady came to the Department of Dermatology of the East Hospital of the First Affiliated Hospital of Sun Yat-sen University to see Director Luo Diqing.
"The moment I met the patient, I was also shocked." Luo Diqing said, "When she lifted her clothes, revealing layers of toilet paper stained with secretions, and opened the toilet paper, she saw the ulcer in her entire abdomen." I receive more than 10,000 patients from all over the country a year, work in dermatology for nearly thirty years, and encounter countless difficult and complicated diseases, but this is the first time I have seen such a large ulcer. ”
After a detailed examination, Director Luo Diqing found that the ulcer surface of the woman's abdomen reached 30cm ×35cm (larger than the eight-inch pizza), surrounded by a slightly raised red edge, and the center was a deep ulcer of 23×18.5cm, reaching deep into the muscle layer, and the undulating movement of the abdominal muscles could be seen when breathing, and the ulcer surface was also stained with many secretions, emitting a burst of putrid odor.
After the examination, Director Luo Diqing immediately took part of the tissue and sent it to pathological biopsy and secretions for bacterial and fungal cultures. "For such a serious ulcer, I greeted the pathology department and asked them to give priority to it; after the pathology film came out, I also invited the professor of the pathology department to consult as soon as possible."
Based on the preliminary examination results, Director Luo Diqing considered that the woman suffered from "gangrenous pyoderma and bacterial infection". Further examination revealed that the woman also had diabetes and that her blood sugar was super high, reaching 39.46 mmol/L! Microbial cultures revealed the growth of a variety of pathogenic bacteria. Subsequent pathological biopsy results exclude infection of specific pathogens as well as neoplastic diseases. The woman was basically diagnosed with "gangrenous pyoderma and bacterial infection".
Luo Diqing introduced that the cause of gangrenous pyoderma is unknown, which may be related to autoimmunity. When ulcers appear, secretions are good bacterial medium, if the local hygiene is not good, it is very suitable for the growth of microorganisms, and bacterial infections further promote the development of ulcers.
Reducing the dose of hormones is another way to exceed the indications for medication
This lady lives in Guangzhou and has been living in Panyu. "Before I came to see Director Luo, this ulcer had been almost two years. It was a little red at first, then it was painful, then it began to fester, and the area gradually expanded. The woman said, "I also went to a number of hospitals to see a doctor, there are external applications, as well as oral medicines, but also used a lot of herbs to apply, but the treatment is not good, the disease is getting worse and worse." This ulcer is not only getting bigger, smells bad, and sometimes has abdominal pain and can't sleep. "Because of this disease, the lady was tortured and did not want to die.
Due to the limited economic conditions of the woman, she refused to be admitted to the hospital for treatment, and Director Luo gave her a system of prednisone, cyclosporine and other drugs in the outpatient clinic, and applied with antibiotic ointment, while actively treating diabetes and controlling blood sugar.
In fact, in response to this rare disease, Professor Luo Diqing is bold and uses drugs for super indications. With the informed consent of the patient, adalimumab injection and tofacib were used.
"Adalimumab injection is a drug for the treatment of rheumatoid arthritis, ankylosing spondylitis, psoriasis, and tofaciplast is also a drug for the treatment of rheumatoid arthritis." Luo Diqing said that because patients have diabetes, blood glucose levels are very high, if the conventional use of large doses of hormone therapy, diabetes may be difficult to control, and may even be aggravated; blood glucose control is not good, the original infection is not easy to control, and will also aggravate the infection, and may induce other complications, the treatment effect may be counterproductive, so it is necessary to find another way and use other treatment methods.
Half a year after the cure, the patient said to get a new life
Under the meticulous treatment of Director Luo, the lesion was quickly controlled and gradually reduced. After 20 days, the condition improved significantly, the ulcer area began to become smaller, and the bottom of the ulcer began to grow granulation. After four months of treatment, the lesion was further reduced. After half a year of treatment, it is now basically healed.
"Thanks to Director Luo for treating my ulcer, I can finally not wrap toilet paper on my abdomen, and I will not be in pain because of this disease, I want to live again."
In the face of the patient's gratitude, Director Luo Diqing waved his hand, but thanked the patient. "I want to thank my patient, who agreed that I used some treatment options that were not available in the textbooks. I would also like to thank my student, Director Liu Jingye, for helping with diabetes and early debridement in the local area. Everyone worked together to cure such a large ulcer in such a short time without skin grafting. ”
The benevolence of the doctor, the active cooperation between the patient and the family is also a great respect and support for the doctor, and the patient is the manifestation of the pathological phenomenon, and the doctor's eyes can only shine wisdom in front of the patient.
There are thousands of skin diseases, the symptoms are similar and complex, Director Luo Diqing suggested that the general public should find a professional doctor for diagnosis and treatment as soon as possible when skin diseases occur.
"In general, if there is itching, most of it is eczema dermatitis or allergies, but it may also be a fungal infection, you can try to apply calamine lotion or hormone-containing drugs yourself, if the effect is not good, you have to go to a regular hospital quickly." For painful diseases, which may be an infection or vasculitis, you can try to apply mopirocin or fusidic acid cream yourself. For sudden skin redness, swelling, heat and pain, and even fever, most of them are bacterial infections, and it is inconvenient to try oral antibiotics first. ”
At the same time, Director Luo Diqing also warned young doctors to read more books and communicate more, "learning without thinking is reckless, thinking without learning is ruined", we must take root in the front line, have more contact with patients in the clinic, and be good at accumulating experience. If you find that you have not seen a case or the treatment effect is not good, you should take the initiative to find information, or ask your peers for advice, so as not to misdiagnose or miss diagnosis.
Editor: Cui Wencan