银屑病–皮肌炎重叠综合征合并肺间质病变1例

A Case of Psoriasis-Dermatomyositis Overlap Syndrome with Pulmonary Interstitial Disease

摘要: 患者男，75岁，全身红斑、丘疹、脱屑、面部浮肿8月，四肢乏力伴吞咽困难2月。前期先后使用阿普米司特、依奇珠单抗 + 大剂量泼尼松疗效不佳，完善肌活检、肌电图、皮肤活检等确诊银屑病–皮肌炎重叠综合征，合并间质性肺病、重度低钾及营养不良等并发症。予糖皮质激素、环孢素、静脉滴注免疫球蛋白联合抗感染、补钾营养支持综合治疗，并辅以中医疗法，患者皮肤及肌肉症状显著改善。本例提示阿普米司特单药对银屑病合并皮肌炎患者疗效有限，激素 + 钙调磷酸酶抑制剂 + IVIG、辅以中医疗法多靶点联合方案可有效控制重叠综合征全身炎症，为同类难治病例提供临床参考。

Abstract: A 75-year-old male patient presented with a generalized red rash, papules, desquamation, and facial edema for 8 months, followed by limb weakness and dysphagia for 2 months. Initial treatments with apremilast and the combination of ixekizumab plus high-dose prednisone yielded poor responses. Following comprehensive diagnostic evaluations, including muscle biopsy, electromyography, and skin biopsy, the patient was diagnosed with psoriasis-dermatomyositis overlap syndrome, complicated by interstitial lung disease, severe hypokalemia, and malnutrition. A multidisciplinary therapeutic regimen was subsequently implemented, comprising glucocorticoids, cyclosporine, intravenous immunoglobulin, anti-infective therapy, potassium supplementation, nutritional support, and adjunctive traditional Chinese medicine. This combined approach resulted in significant improvement in both cutaneous and muscular symptoms. This case suggests that apremilast monotherapy has limited efficacy in patients with psoriasis complicated by dermatomyositis. A multi-target combination strategy involving corticosteroids, calcineurin inhibitors, intravenous immunoglobulin, and adjunctive traditional Chinese medicine may effectively control systemic inflammation in overlap syndrome, providing a clinical reference for similar refractory cases.