紫杉醇致扁平苔藓样药疹1例

A Case of Lichenoid Drug Eruption Caused by Paclitaxel

患者女,62岁,双下肢红斑、丘疹伴痒2个月,加重伴全身泛发1个月。躯干及四肢弥漫性红斑、丘疹,上覆少量鳞屑,伴双侧颊黏膜的破溃。发疹前8个月右侧"乳腺恶性肿瘤切除术"后行紫杉醇化疗半年余。皮损组织病理示:表皮角化不全,毛囊角栓,棘层肥厚,基底细胞液化,可见坏死角质形成细胞,真皮血管周围大量淋巴细胞、少数嗜酸性粒细胞浸润。直接免疫荧光:IgG(-),IgA(-),C3(-)。诊断:扁平苔藓样药疹。

A 62-year-old female presented with erythema,papules with pruritus on the bilateral lower extremities for two months,and aggravation with all of the body for one month.Diffuse erythema and papules were seen on her trunk and limbs,covered with a small amount of scale,accompanied by ulceration in the oral mucosa.Eight months before the rash,because of "malignant tumor resection of the breast" on the right side,paclitaxel chemotherapy was given for more than half a year.Histopathology showed epidermal parakeratosis,follicular horn plug,spinous layer hypertrophy,liquefaction degeneration of the basal cell layer,necrotic keratinocytes were seen in the epidermis,perivascular infiltration of numerous lymphocytes and a few eosinophils in the dermis.Direct immunofluorescence: IgG(-),IgA(-),C3(-).The diagnosis was lichenoid drug eruption.