牛黄解毒片致固定性药疹及药物诱发大疱性类天疱疮1例  

A case of fixed drug eruption and drug induced bullous pemphigoid induced by bezoar detoxification pills

作　　者：何娟 杨怡 周勇 王睿 李承新 HE Juan;YANG Yi;ZHOU Yong;WANG Rui;LI Chengxin(Department of Dermatology,the Ith Medical Center of PLA General Hospital,Bejing 100853,China)

机构地区：[1]中国人民解放军总医院第一医学中心皮肤科,北京100853

出　　处：《实用皮肤病学杂志》2024年第2期123-125,共3页Journal of Practical Dermatology

基　　金：国家自然科学基金资助项目(82273530)。

摘　　要：33岁男性患者,主因皮肤紫红色斑片、口腔及生殖器黏膜糜烂反复发作3年余,双手局部水疱5d入院。皮肤科情况:右眶周、口周、右肘部、右小腿可见类圆形紫红色斑片,口腔及生殖器黏膜浅表糜烂,双手指端散在数枚紧张性水疱。实验室检查示:疱病抗体BP180升高。小腿红斑组织病理示:表皮可见坏死的角质形成细胞,真皮浅层可见淋巴细胞为主的炎性细胞浸润。右手示指水疱组织病理示:表皮下水疱,疱内以嗜酸粒细胞及淋巴细胞为主的炎性细胞浸润。水疱周围正常皮肤直接免疫荧光示:IgG和补体3(C3)线性沉积于表皮与真皮之间。诊断:固定性药疹;药物诱发大疱性类天疱疮。予醋酸泼尼松龙30mg,每日1次口服,治疗1周后减量至15mg,每日1次继续服用3d,10mg每日1次服用4d后停药,局部对症治疗,终身禁用牛黄解毒片,患者病情迅速控制,1年后随访患者病情未再复发。The patient,a 33-year-old male,was admitted to hospital due to recurrent erythematous patches on the skin,oral and genital mucosal erosions for over 3 years,and developed localized blisters on both hands within the past 5 days.The dermatological examination revealed circular erythematous patches around the right eye orbit,perioral area,right elbow,and lower leg on the right side.Superficial erosions were observed on the oral and genital mucosa,along with scattered tense blisters on the fingertips.The laboratory examination revealed heightened levels of BP 180 antibodies associated with pemphigoid.The histopathological examination of the erythematous lesions of the lower leg demonstrated necrotic keratinocytes in the epidermis and a predominantly lymphocytic inflammatory infiltrate in the superficial dermis.The histopathological examination of the blistered areas of the right index finger revealed subepidermal blisters characterized by inflammatory infiltrates mainly composed of eosinophils and lymphocytes.The direct immunofluorescence of perilesional skin showed a linear deposition of IgG and complement C3 between the epidermis and dermis.The patient was diagnosed as fixed drug eruption with drug-induced pemphigus.The treatment regimen involved administration of oral prednisone at 30 mg/day for one week,tapered to 15 mg/day for 3 days,followed by 10 mg/day for 4 days before discontinuation.The patient received symptomatic local therapy was advised against use of bezoar detoxification pills for life.The patient's condition was rapidly controlled,and there was no recurrence during the one-year follow-up.

关 键 词：药疹 固定性药疹 牛黄解毒片 类天疱疮 大疱性 

分 类 号：R758.25[医药卫生—皮肤病学与性病学] R758.66[医药卫生—临床医学]