硫酸羟氯喹致急性发热性嗜中性皮病1例分析

Analysis of a case of acute febrile neutrophilc dermatosis caused by hydroxychloroquine sulfate

1例48岁女性患者因类风湿性关节炎服用硫酸羟氯喹和甲氨蝶呤,2周后躯干和四肢部位出现触痛性红斑、丘疹,伴发热,皮肤活检提示真皮浅中层中性粒细胞浸润。停药并给予甲泼尼龙琥珀酸钠、卤米松乳膏等治疗18 d后好转,诊断为急性发热性嗜中性皮病。该病例发生的急性发热性嗜中性皮病与硫酸羟氯喹关联性评价结果为“很可能有关”,国内尚无相关文献报道。硫酸羟氯喹致急性发热性嗜中性皮病的发病机制可能与粒细胞集落刺激因子水平升高、细胞因子调节异常和遗传易感性有关。停用可疑药物并应用糖皮质激素是目前最有效的治疗手段。

A 48-year-old female patient was treated with hydroxychloroquine sulfate and methotrexate for rheumatoid arthritis.After two weeks,tender erythema and papules appeared on the trunk and limbs,accompanied by fever.Skin biopsy was suggestive of neutrophilic infiltration in the superficial mesodermal layer of the dermis.After hydroxychloroquine sulfate withdrawal and 18 days of methylprednisolone sodium succinate and halometasone cream treatment,she improved and was diagnosed with acute febrile neutrophilic dermatosis.By correlation analysis,the causal relationship between acute febrile neutrophilic dermatosis and hydroxychloroquine sulfate was evaluated as“most likely”,which had not been reported in China.The pathogenesis of hydroxychloroquine sulfate-induced acute febrile neutrophilic dermatosis may be related to elevated granulocyte-colony stimulating factor levels,abnormal cytokine regulation,and genetic susceptibility.Discontinuation of the suspected drug and application of glucocorticoids are currently the most effective treatment.