心脏起搏器植入诱发大疱性类天疱疮1例

Bullous Pemphigoid Induced by Cardiac Pacemaker Implantation: A Case Report

患者男,90岁,胸腹部红斑水疱3个月。发病前患者因冠心病植入心脏起搏器,植入后20 d首先于安装部位皮肤出现红斑、水疱,后皮损波及前胸、腹部、背部、上肢。皮损组织病理示:表皮下水疱,真皮浅层嗜酸性粒细胞、淋巴细胞浸润。直接免疫荧光(direct immunofluorescence, DIF)示:表皮基底膜C3阳性线状沉积,IgG、IgM、IgA阴性。间接免疫荧光(indirect immunofluorescence, IIF)示:抗表皮基底膜循环抗体IgG 1∶40阳性。临床表现结合病理诊断为大疱性类天疱疮。治疗:给予口服醋酸泼尼松30 mg/d,配合补钙护胃等治疗,病情控制可。

A 90-year-old male presented with erythema and blisters in thorax and abdomen for 3 months.He underwent a surgery for installing cardiac pacemaker because of coronary heart disease.Twenty days after the surgery, erythema and blisters firstly appeared on the skin area of the installation site, then similar lesions affected the forechest, abdomen, back, and upper limbs.Histopathological examination revealed subepidermal blister, eosinophils and lymphocytes infiltrated the superficial dermis.Direct immuno-fluorescence showed positive linear deposition for C3 in the epidermal basement membrane, but negative for IgG,IgM and IgA.Indirect immunofluorescence showed positive for circulating antibody IgG of anti epidermal basement membrane, its titer 1∶40.Diagnosis of bullous pemphigoid was confirmed by combining clinical manifestations with pathological features.Prednisone acetate orally 30 mg per day was given with calcium supplements and gastric medicines.The disease was under control.