文献简介

出版社:JAMA

作  者:Jessica Wu,BA;Mengjun Hu,MD;Suzanne M.Sachsman,MD

编  号:

关键字:环状红斑;

年  份:2020   点击量:85

文献摘要 全文翻译

A woman in her 70s with recurrent primary peritoneal carcinoma receiving pembrolizumab and ipilimumab presented to the Division of Dermatology with a pruritic rash that had been ongoing for 2 weeks. The rash started as an erythematous papule on her right arm 2 months after initiation of a new immunotherapy regimen, then gradually enlarged and spread to involve both legs (Figure, A and B). She denied any new systemic symptoms associated with on set of the rash. A recent trial of oral terbinafine for possible tinea corporis yielded no improvement. Physical examination revealed erythematous annular plaques without scale on her right arm and bilateral legs. A 4-mm punch biopsy was obtained from the patients right arm (Figure, C and D), and she was prescribed fluocinonide, 0.05%, ointment. She returned to the clinic 3 weeks later with resolution of pruritus but enlarging lesions. Her last dose of ipilimumab was 2 months prior, and she was scheduled to receive pembrolizumab with doxorubicin, carboplatin, and prednisone for treatment of her underlying malignant tumor. For management of her rash, the patient was prescribed betamethasone dipropionate, 0.05%, ointment(augmented).

患者女性,70余岁,原发性腹膜癌复发,接受帕博利珠单抗和伊匹木单抗治疗,因持续2周瘙痒性皮疹就诊皮肤科。在开始新的免疫治疗2个月后,右手臂开始出现红斑丘疹随后逐渐扩大并累及双腿(图AB)。患者否认出现任何与皮疹相关的新的全身症状。近期试验发现,口服特比萘芬治疗,未见改善。体格检查发现右臂和双侧腿部无鳞屑环状红斑患者右臂行4mm穿刺活检(图CD),患者采用0.05醋酸氟轻松治疗。3周后,患者复诊,瘙痒消退,但皮损扩大。患者2个月前最后一次使用伊利木单抗,并计划接受帕博利珠单抗、多柔比星卡铂和泼尼松治疗潜在恶性肿瘤。为治疗皮疹,给以患者0.05%倍他米松双丙酸酯药膏(增强剂)治疗