新冠疫苗之施打與皮膚軟組織發炎之鑑別診斷

From COVID Arm to Cellulitis Mimics

施打新冠病毒疫苗後，有大約1.5％的人會產生「COVID arm」的遲發性過敏反應，甚至被當作蜂窩組織炎而給予了抗生素治療。因此，本文探討診斷蜂窩組織炎的謬誤，根據統計大約有三分之一被診斷為蜂窩組織炎的「蜂窩組織炎相似症」（cellulitis mimics），並非真正蜂窩組織炎，因而造成後續處理上的問題，這些疾病包括：其他表淺感染症（如：帶狀皰疹（herpes zoster）、癰（carbuncle）、甲溝炎（paronychia）等）、或壞死性筋膜炎與感染性關節炎／骨髓炎等深部感染；或深部靜脈栓塞等靜脈淋巴疾病、接觸性皮膚炎等皮膚過敏性疾病、痛風與結節性紅斑（erythema nodosum）；骨關節與風濕性疾病及惡性腫瘤相關的皮膚表徵等的非感染症。這些都需要詳細的鑑別診斷。只有依賴詳盡的病史詢問與仔細的理學檢查，才能確切地分辨是蜂窩組織炎等感染性疾病或是其他cellulitis-mimics的非發炎性疾病，而能給予病人最妥善的處置，也減少不必要的抗生素使用。

After administering coronavirus disease 2019 (COVID-19) vaccination, 1.5% of recipients have developed delayed hypersensitivity cutaneous reaction designated as ''COVID arm'', which often has been misdiagnosed as cellulitis and treated with antibiotics. Generally, one-third of cellulitis cases do not have true cellulitis. These cellulitis mimics include superficial cutaneous infections (such as herpes zoster, carbuncle, and paronychia), deep infections (such as necrotizing fasciitis, septic arthritis, and osteomyelitis), venous disorders (for example, deep vein thrombosis, etc.), allergic disorders (e.g. contact dermatitis, etc.), rheumatologic disorders, (e.g. gout and erythema nodosum, and malignancy-related cutaneous manifestations. Based on the detailed history of medical records and physical examinations, accurate differential diagnosis can be done to provide appropriate management.