银屑病长期低剂量服用甲氨蝶呤导致药疹1例  

A Case of Drug Eruption Induced by Long-Term Administration of Low dose Methotrexate During the Treatment of Psoriasis

作　　者：韩静倩 纪华安[1] 孔祥君[1] HAN Jingqian;JI Huaan;KONG Xiangjun(Department of Dermatology,Affiliated Hospital of Tianjin Institute of Traditional Chinese Medicine,Tianjin 300120,China)

机构地区：[1]天津市中医药研究院附属医院皮肤科,天津300120

出　　处：《中国皮肤性病学杂志》2021年第1期87-89,共3页The Chinese Journal of Dermatovenereology

摘　　要：患者女,58岁,全身红斑、丘疹、鳞屑反复发作十余年,多发糜烂、溃疡10 d。平时间断服用甲氨蝶呤片2年。皮肤科情况:全身多发性暗红色斑片,上覆鳞屑,部分斑片上可见糜烂、溃疡,口腔黏膜和肛周可见散在破溃糜烂面。患者同时伴有腹痛、腹泻。皮损组织病理:表皮缺失,浅表糜烂,真皮浅层水肿,小血管增生、扩张,较多淋巴细胞、组织细胞、中性粒细胞及少量嗜酸性粒细胞浸润。直接免疫荧光:表皮细胞间与基底膜IgG(-)、IgA(-)、C3(-)。实验室检查示全血细胞减少,肝功能异常。诊断:甲氨蝶呤药疹。A 58-year-old female with a more than 10-year-history of psoriasis presented multiple erosions and ulcers for 10 days following intermittent methotrexate administration for 2 years.Dermatological examination revealed multiple dark erythema and plaques with scales all over the body.Erosions and ulcers could be seen on part of theplaques.Erosions of oral and perianal mucosa were also observed.She had concomitant symptoms of abdominal pain and diarrhea.Skin biopsy showed epidermal deficiency and superficial erosions.The upper dermis was hydropic and small vessels were hyperplastic and ectatic.Perivascular infiltration of lymphocytes,histocytes,neutrophils and a small number of eosinophils were observed.Sedimentation of IgG,IgA and C3 between the epidermal cells and on the basilar membrane were negative as showed by direct immunofluorescence.The laboratory tests revealed pancytopenia and abnormal liver function.The diagnosis of methotrexate-induced drug eruption was made based on these findings.

关 键 词：药疹 甲氨蝶呤 银屑病 

分 类 号：R758.25[医药卫生—皮肤病学与性病学] R758.63[医药卫生—临床医学]