2024年 · 第62卷第09期

The patient, a 43-year-old female, came to our hospital on October 23, 2023 due to "multiple nodules in her left hand for 5 months, and a mass in her left axilla was found for more than 3 months". Five months ago, the patient developed multiple purple-red nodules at the tips of five fingers of his left hand without obvious trigger, accompanied by pressing pain (Figure 1A). Three months ago, the patient felt soreness in the left upper limb and palpated the left axillary mass. CT angiography in an external hospital showed aneurysmal dilatation of the left brachial artery with thickening of the arterial wall (Figure 1B). For further diagnosis and treatment, he went to the outpatient clinic of rheumatology and immunology department of our hospital. The laboratory results showed that there were no abnormalities in the immune indexes such as erythrocyte sedimentation rate, C-reactive protein and antinuclear antibody, and immune vasculitis was basically excluded. Consultation with dermatology and vascular surgery was recommended. The patient visited the dermatology clinic of our hospital on October 26, 2023, and underwent a left hand skin nodule biopsy. The pathological examination results showed skin hyperkeratosis, epidermal atrophy, intradermal vascular proliferation, endothelial cell swelling, surrounding dense lymphocyte and eosinophil infiltration, and was diagnosed as angiolymphoid hyperplasia with eosinophilia (ALHE). Cryotherapy was given to the nodule at the end of the left finger, and oral prednisone (15 mg, once a day) and methotrexate (12.5 mg, once a week) were given at the same time. The patient attended the vascular surgery clinic of our hospital on November 5, 2023. Physical examination: pulsatile mass in the middle and upper segment of the left upper arm, multiple purple-red nodules the size of mung beans at the tips of five fingers of the left hand, accompanied by pressing pain. The patient had no previous history of left upper limb trauma and surgery. Combined with the results of CT angiography in other hospitals, considering the occupation of left brachial artery, he was admitted to the vascular surgery ward.