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患者男,24岁.鼻、口周水疱、脓疱、糜烂、结痂40d,泛发全身半个月.患者曾诊断为泛发性脓疱疮.皮肤科情况:面部、背部、外阴、双足散在分布大小不等水疱、脓疱,其上见糜烂面、少量脓性分泌物及黄色痂壳;双足趾表面皮肤发黑,趾间可见糜烂、浸渍,伴肿胀;口腔及外阴黏膜均可见大小不一的糜烂面.脓疱细菌培养无细菌等生长,糜烂面分泌物培养分别为大肠埃希菌及奇异变形杆菌;皮损病理检查示:表皮内基底层上大疱,疱腔内可见棘层松解细胞及混合炎细胞浸润.直接免疫荧光示:角质形成细胞间网状IgG(2+),C3(+)沉积;血清桥粒芯蛋白抗体Dsg1,3均(+).诊断:寻常型天疱疮.系统使用糖皮质激素,疗效佳,2周后好转出院.“,”A 24-year-old male presented with blisters,pustules,erosion and scabs around nose and mouth for 40 days,and spread to the whole body for half a month.He was misdiagnosed as generalized impetigo.Blisters and pustules with different sizes spread all over the body,some of which ulcerated and developed to erosion,with small amount of pus and crusts.The skin on the toes of both feet was black with brown crust,double feet swelled.Erosions with different sizes found in oral and genital mucosa.The bacterial culture of pustules was negative,but the bacterial culture of erosion were Escherichia coli and Proteus mirabilis.Histopathological examination showed suprabasilar acanthlysis and blister formation.The presence of acantholytic cells were in the bulla cavity.Direct immunofluorescence showed intercellular keratinocyte mesh IgG (2 +),C3 (+) deposition were found.Desmoglein antibodies Dsg1 and Dsg3 were positive.The case was diagnosed as pemphigus vulgaris.Corticosteroid therapy was effective.His condition improved markedly after 2 weeks,and was discharged from hospital.