口服阿莫西林后发生天疱疮

Amoxicillin-induced pemphigus:a case report

报告1例口服阿莫西林后发生天疱疮的病例。患者男,40岁。因全身出现红斑、水疱1个月后就诊。1个月前患者全身皮肤出现散在黄豆大红斑、瘙痒,2d后在红斑和正常皮肤上出现水疱,水疱破裂后干燥结痂,但仍有新发水疱,皮损多分布在胸、背、颈部和腋下。经口服泼尼松20mg/d治疗2周后,皮损基本消退,5d前全身又出现红斑和水疱,皮损瘙痒。患者2次发病前均有口服阿莫西林史。皮肤科检查:躯干和四肢可见大小不一的散在水肿性红斑,部分红斑上可见松弛性水疱,尼氏征阳性,皮损组织病理检查示表皮内水疱和棘刺松解细胞,免疫组化组织病理示在表皮内IgG、C3呈网状沉积。体外γ干扰素释放实验阳性。最终诊断为药物诱发的天疱疮。

A 40-year old male complained of erythema and vesicles for 1 month and visited the hospital in Feb.2007.One month ago pruritic soybean-sized erythema scattered over the trunk and extremities,and vesicles appeared on the erythematous and normal skin 2 days later,the vesicles broke and crusted quickly,however, new vesicles continue to occur and mainly distributed over the trunk,neck and axillae.The general condition of the patient was good,and had no fever.Prednisone 20 mg was given to the patient,2 weeks later,the skin lesions disappeared on the whole.Five days ago,the patient visited the hospital because of the reappearance of pruritic erythema and vesicles.Before the tWO onsets of the skin lesions the patient had taken amoxicillin to treat infections.Physical examination showed there were various sized edematous erythemas on the trunk and extremities.and flaccid vesicles appeared on some of the erythenmas.Nikolsky＇s sign was positive.Histopathology of vesicle and the pefilesional skin revealed intraepidermal blister formation and acantholytic cells.Direct immunofluorescencc demonstrated IgG/C3 deposited in reticular form in the epidermis.The diagnosis of amoxicillin-induced pemphigus was made.