羟基脲致足部溃疡误诊为糖尿病足一例

A Case Report of Hydroxyurea-Induced Foot Ulcer Misdiagnosed as Diabetic Foot

摘要: 羟基脲致足部溃疡是骨髓增殖性疾病治疗中罕见却易被误诊的药物不良反应，其与糖尿病足的临床特征重叠常导致诊治延误。本文通过回顾性分析1例特发性血小板增多症患者长期服用羟基脲后出现足部溃疡并被误诊为糖尿病足的临床资料，结合相关文献探讨其发病机制、误诊原因及鉴别策略。该患者为68岁女性，2型糖尿病史5年，特发性血小板增多症病史1年，规律口服羟基脲(0.5 g 3次/日)联合皮下注射干扰素α2b (300万单位2次/周)治疗；因双足足跟溃疡入院后，初期基于糖尿病史诊断为糖尿病足，经多学科会诊及停药后溃疡逐步愈合的动态观察，最终修正诊断为羟基脲致足部溃疡。本研究提示，羟基脲相关足部溃疡与糖尿病足在发病机制、临床特征上存在本质差异，临床需通过全面病史采集、多学科协作评估及治疗反应监测进行精准鉴别，以减少误诊并优化患者预后。

Abstract: Hydroxyurea-induced foot ulceration is a rare but frequently misdiagnosed drug reaction during the treatment of myeloproliferative neoplasms. Its overlapping clinical features with diabetic foot often led to diagnostic and therapeutic delays. This report presents a retrospectively analyzes a case of essential thrombocythemia (ET) in which long-term hydroxyurea therapy resulted in foot ulcers misdiagnosed as diabetic foot. We discuss the pathogenesis, causes of misdiagnosis, and strategies for differentiation based on this case and relevant literature. The patient, a 68-year-old woman with a 5-year history of type 2 diabetes and a 1-year history of ET, was on regular oral hydroxyurea (0.5 g three times daily) combined with subcutaneous interferon-α2b (3 million units twice weekly). She was admitted with bilateral heel ulcers that led to an initial diagnosis of diabetic foot based on her diabetes history. Subsequent multidisciplinary consultation and the observation of progressive ulcer healing following hydroxyurea discontinuation led to the correct diagnosis of hydroxyurea-induced foot ulceration. This case highlights the intrinsic differences in pathogenesis and clinical presentation between hydroxyurea-associated foot ulcers and diabetic foot. Comprehensive medical history-taking, multidisciplinary assessment, and therapeutic response monitoring are essential for accurate differentiation, reducing misdiagnosis, and optimizing patient outcomes.