全身性紅斑狼瘡合併雷諾氏症候群及手指、腳趾壞死－－一病例報告及文獻回顧

Systemic Lupus Erythematous with Raynaud's Phenomenon and Digits Gangrene-- A Case Report and Literature Review

一位58歲的女性是全身性紅斑狼瘡的病人，一年前她開始受苦於雷諾氏症候群，這次住院是因手指及腳趾發紺疼痛愈來愈厲害。此病人本身也患有糖尿病、抗磷酯症候群及慢性C型肝炎，手指皮膚切片證實有血管炎，所以她接受鈣離子阻斷劑、肝素、大量類固醇、大量免疫抑制劑、血漿交換術等多種治療方法，但均無效。手指及腳趾最後壞死而自然脫落。

We reported a patient with systemic lupus erythematosus complicated by Raynaud's phenomenon. She was also a case of diabetes mellitus, antiphospholipid syndrome and chronic hepatitis C infection. Skin biopsy of a fingertip revealed leukocytoclastic vasculitis. Hence vasculitis induced Raynaud's phenomenon was suspected. She received the following treatment-- nifedipine, intravenous heparin, large amount of prednisolone (60~100 mg.q.d.), pulse cyclophosphamide, plasma exchange, prostaglandin E1 azathioprine (100 mg q.d,), pulse steroid and triiodothyronine. But these drugs were not effective. Gangrenous change of her fingers and toes were the final results. She refused to receive surgical intervention and autoamputation of her digits was the final result.