带状疱疹继发大疱性类天疱疮Wolf同位反应1例

Wolf's isotopic response:a case of localized bullous pemphigoid on the herpes zoster scar

报告1例带状疱疹瘢痕处出现局限性大疱性类天疱疮的Wolf同位反应。患者女,68岁,左侧胸背部瘢痕处水疱2个月。皮肤科检查:左腋下可见一直径约10 cm×5 cm瘢痕,瘢痕中央5 cm×5 cm深在溃疡,轻度渗液,上覆黑褐色痂皮,瘢痕边缘见5个黄豆至花生米大小水疱,疱液清,疱壁紧张,尼氏征阴性;胸中部近左侧T2~T4区见一直径约3 cm×2 cm增生性瘢痕,瘢痕表面见2个黄豆大小水疱;左背部两处增生性瘢痕,表面见一直径约1.5 cm水疱及一直径约1 cm糜烂面,表面少许脓性分泌物,无黏膜受累。背部皮损组织病理检查:表皮下疱,真皮浅层血管周围少量淋巴组织细胞、嗜中性粒细胞、浆细胞浸润,直接免疫荧光示基膜区C3线状沉积。诊断为带状疱疹继发大疱性类天疱疮同位反应。予口服激素治疗后,水疱在2周内消退,2个月后左腋下溃疡愈合,瘢痕稍平。随访15个月未见复发,目前仍在随访中。

A case of Wolf's isotopic response is reported.A 68-year-old-female presented with vesicles and bullae on the scars of the left chest and the back for 2 months.Dermatological examination revealed five vesicles and bullae of various sizes on the edge of a 10 cm×5 cm scar,with a deep central ulcer sized 5 cm×5 cm,under the left armpit.Ulcer was with little discharge and dark crusts.The vesicles were with clear fluid and negative for Nikolsky's sign.Two bullae were seen on a 3 cm×2 cm hypertrophic scar at T2 to T4 of the left anterior chest.One hypertrophic scar with a bulla sized 1.5 cm and another one with 1 cm erosion and pustular secretion were on the left back.Patient had no mucosal involvement.Histology of skin lesion showed subepidermal blister and perivascular infiltrates of a few lymphohistiocytes,neutrophils and plasma cells in the superficial dermis.Direct immunofluorescence showed linear deposition of C3 in the basement membrane zone.The diagnosis was isotopic response:bullous pemphigoid secondary to herpes zoster.After the treatment with oral prednisone acetate,the blisters resolved in 2 weeks.No recurrence was observed during 15-months follow-up.The follow-up is still ongoing.