甲氨蝶呤所致特殊表现的药疹3例

Three cases of drug eruption with special manifestations induced by methotrexate

报告3例甲氨蝶呤所致特殊表现的药疹。3例患者中2例为女性,年龄分别为48岁和82岁,既往均有银屑病史,临床表现为躯干、四肢的红斑、糜烂。1例为54岁男性患者,既往有类风湿关节炎病史,临床表现为双足跟的疼痛性红斑、水疱。3例患者均有明确的甲氨蝶呤用药史,均伴黏膜损害、骨髓抑制及低蛋白血症。有2例患者亚甲基四氢叶酸还原酶的活性降低。组织病理检查2例患者表皮内可见角化不良细胞及核分裂象。诊断:药疹。

Three cases of drug eruption with special manifestations induced by methotrexate are reported.Two of the patients were female(one aged 48 years and the other 82 years),both with a history of psoriasis.Their clinical manifestations were erythema and erosions on the trunk and limbs.The other patient was a 54-year-old male with a history of rheumatoid arthritis.His clinical manifestations included painful acroerythema and blisters.All patients had a history of methotrexate use prior to the onset of the disease.All cases suffered mucosa damage,myelosuppression and hypoproteinemia.Two patients had reduced methylenetetrahydrofolate reductase activity.Histologically,necrotic keratinocytes and mitotic phases were observed in the epidermis of two patients.The diagnosis of drug eruption was made.