文献简介

出版社:JAMA Dermatology

作  者:

编  号:

关键字:抗层黏连蛋白γ1类天疱疮

年  份:2017   点击量:177

文献摘要 全文翻译

A woman in her 80s presented with a 1-year history of pruritic erythema on the trunk and extremities. The erythema did not respond to topical corticosteroid, oral roxithromycin (300 mg/d), or narrow-band UV-B phototherapy. The patient had a history of type 2 diabetes and hypertension and was treated with glimepiride, sitagliptin phosphate hydrate, and amlodipine besylate. The patient also had polymyalgia, which was treated with a low dose of prednisolone. The prednisolone therapy had been discontinued 2 months before her visit to the dermatology clinic when she had been hospitalized with pneumonia. Multiple tense blisters had subsequently appeared on the palms. Physical examination at the first visit revealed scaly erythematosus plaques on the whole body and tense blisters on the arms, hands, soles, and buttocks. Neither scar formation or mucosal involvement was observed. A skin biopsy specimen was obtained from a bulla on the forearm. Histopathologic analysis revealed a subepidermal bulla with inflammatory infiltrates of neutrophils. The results of an IgG chemiluminescence enzyme immunoassay for bullous pemphigoid (BP) 180 noncollagenous(NC)16A were negative. After treatment with oral prednisolone, 20mg/d, the lesions healed without scar or milia formation (Figure 1).

患者女性,80余岁,躯干和四肢有1年瘙痒性红斑病史。局部糖皮质激素、口服罗红霉素(300 mg / d)或窄带UV-B光疗对红斑无效。该患者有2型糖尿病和高血压病史,并采用格列美脲、磷酸西格列汀和苯磺酸氨氯地平治疗。患者还患有多肌痛,采用低剂量泼尼松龙治疗。患者因肺炎入院治疗,且在就诊皮肤科前2个月停用泼尼松龙。随后患者手掌出现多个紧张水疱。首次就诊体格检查显示全身鳞状红斑,手臂、手、足底和臀部出现紧张水疱。未见瘢痕形成或粘膜受累。从前臂大疱处取皮肤活检标本。组织病理学分析显示表皮下大疱伴中性粒细胞炎性浸润。大疱性类天疱疮(BP)180非胶原(NC)区16A IgG化学发光酶免疫测定结果为阴性。口服泼尼松龙(20mg / d)治疗后,皮损愈合,无瘢痕或粟粒疹形成(图1)。