英夫利西单抗诱发脓疱性银屑病一例

A case of pustular psoriasis induced by infliximab

44岁女性患者,掌跖红斑、丘疹、脓疱20 d。既往强直性脊柱炎病史12年,近期复发后接受英夫利西单抗治疗,强直性脊柱炎病情明显改善,但手足出现红斑、丘疹和脓疱。皮肤科情况:双手、双前臂和双足散在浸润性红斑、丘疹和脓疱,部分皮损上覆痂皮,右足内侧见脓疱融合。皮损组织病理:棘层上部可见中性粒细胞浸润,形成脓疱,棘层肥厚,上皮脚下延,真皮浅层血管丛周围淋巴细胞及中性粒细胞浸润。诊断:脓疱性银屑病(英夫利西单抗诱发)。治疗:停用英夫利西单抗,甲氨蝶呤10mg每周1次、阿维A胶囊10mg每日1次、复方甘草苷酸50 mg每日3次口服。3个月后,皮损完全消退,随访6个月无复发。

A 44-year-old female presented to our clinic with chief complaint of recurrent erythema and pustules in hands and feet for 20 days. The patient had a background of ankylosing spondylosis for 12 years, and received standard treatment of infliximab because of th recurrence of the disease recently. The condition of ankylosing spondylosis significantly improved after the treatment, but recurrent erythem and pustules in hands and feet developed. Dermatologic physical examination: Erythema, plaque, papules and pustules scattered in hands and feet. Histopathologic examination: psoriasiform changes(parakeratosis and elongated rete ridges) of the epidermis;perivascular lymphocyte infiltrated predominantly in the upper dermis;numerous neutrophils emigrated into the epidermis, which formed the spongiform micropustule of Kogoj. Diagnosis: pustular psoriasis induced by infliximab. For the treatment, infliximab was discontinued, methotrexate(10 mg once week), acitretin(10 mg once daily) and compound glycyrrhizin tablets(50 mg 3 times daily) were taken orally. After 3 months of treatment all the skin lesions subsided and no relapse was observed during the fellow-up of 6 months.