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病例—药物性红斑狼疮的临床表现、治疗与诊断

2018-11-2 17:08| 发布者: 朱超| 查看: 3745| 评论: 158

简介:药物性红斑狼疮病例药物性红斑狼疮的临床表现实验室检查药物性红斑狼疮治疗药物性狼疮诊断 一名女患者四十八岁,因反复面颈部红斑、关节疼痛1个月,加重并出现口腔溃疡3d就诊、入院前一个月患者颜面出现片状红斑, ...


1药物性红斑狼疮病例

    一名女患者四十八岁,因反复面颈部红斑、关节疼痛1个月,加重并出现口腔溃疡3d就诊、入院前一个月患者颜面出现片状红斑,之后皮疹渐增多并累及其他曝光部位。后出现双侧膝、肘、指关节疼痛不适,活动受到限制且进行性加重。入院前三天患者皮疹再次加重、患者于发疹前2个月因病服用多种药物治疗(明确使用的药物有氯丙嗪片剂,其余不详),发疹后仍间断服用上述药物、本次加重前曾单独服用氯丙嗪。

病例—药物性红斑狼疮的临床表现、治疗与诊断40 作者: 来源:

2药物性红斑狼疮的临床表现

    面部肿胀明显,面颊部、颈部、前胸“V”字区见片状浸润性红斑、暗红斑,其上散在少许松弛性水疱且尼氏征阴性、部分疱壁破溃见浅表红色糜烂面、上覆痂壳及鳞屑、口腔上腭见数个米粒大小水疱,口唇见数个糜烂面,上覆血痂及药痂、双前臂亦见大小不一暗红斑,部分中央轻度坏死,似“靶形损害”。

病例—药物性红斑狼疮的临床表现、治疗与诊断24 作者: 来源:

3实验室检查

    丙氨酸转氨酶、γ谷氨酰转肽酶升高。血清抗核抗体(ANA)阳性(一比一百、均质型),抗Ro抗体阳性,抗核糖核蛋白抗体P阳性且抗组蛋白抗体阳性。前胸“V”字区皮损组织病理示表皮坏死、真皮上层淋巴细胞浸润。面部皮疹激光共聚焦显微镜检查示表皮变薄、灶性增生、角化亢进、基底细胞液化变性、真皮乳头及浅层毛细血管扩张和充血、血管和部分毛囊周围大量嗜黑素细胞及炎症细胞浸润、结合患者病史及实验室检查诊断为药物性红斑狼疮(DILE)。

病例—药物性红斑狼疮的临床表现、治疗与诊断21 作者: 来源:

4药物性红斑狼疮治疗

    立即停服可疑致敏药物给予甲泼尼龙静脉滴注抗炎、抗免疫治疗等。治疗1周后患者皮疹、关节肌肉疼痛亦缓解。此后激素逐渐减量。停用激素当日检查血清ANA阳性(一比四十、均质型),抗Ro抗体阳性且抗组蛋白抗体阴性。

病例—药物性红斑狼疮的临床表现、治疗与诊断96 作者: 来源:

5药物性狼疮诊断

    目前对于DILE尚无特异性的诊断标准、一般认为符合以下条件即可诊断:患者出现红斑狼疮样临床表现和血清学异常、抗核抗体阳性;在症状出现前数周或数年有使用可疑药物的病史、在使用可疑药物前无自身免疫性疾病病史、停用该药物并给予对症治疗后临床症状能迅速缓解或消退再次使用该药物后临床症状复发加重、我们报道的该例患者符合以上4点故支持DILE的诊断、DILE的治疗原则是及早停用相关药物然后根据病情采取措施。




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