依奇珠单抗致白塞病样症状及湿疹样皮疹

Behcet′s disease symptoms and eczema‑like rash caused by ixekizumab

1例32岁女性患者为治疗掌跖脓疱病使用依奇珠单抗皮下注射(首次160 mg,之后80 mg、1次/2周)。用药4次后患者手足部位红斑、脓疱有所改善;用药6次后,全身出现红斑、丘疹,伴明显瘙痒;用药9次后,双下肢出现结节性红斑及口腔部溃疡,引发湿疹及白塞病样症状。实验室检查示超敏C反应蛋白>5.0 mg/L,总IgE 2.0×10^(6) IU/L,红细胞沉降率56 mm/1 h,其他检查均未见异常。病理学检查示真皮全层血管周围少量至中等量淋巴细胞浸润,皮下脂肪组织层内散在分布数个结节,中央为组织细胞,部分呈上皮样形态,周围有少量淋巴细胞及中性粒细胞,过碘酸雪夫染色和抗酸染色均阴性。患者停用依奇珠单抗并经抗过敏、抗炎和外用糖皮质激素治疗2周后症状好转。随访2个月,患者湿疹及白塞病样症状未见复发。

A 32-year-old female patient received ixekizumab injection(initially 160 mg,then 80 mg,once every 2 weeks)for palmoplantar pustulosis.After 4 times of medication,erythema and pustules of hands and feet were improved;after 6 times of medication,the patient developed erythema and papules all over the body,accompanied by obvious pruritus;after 9 times of medication,erythema nodosum and oral ulcers appeared on both lower extremities,causing eczema and Behcet′s symptoms.Laboratory tests showed hypersensitive C-reactive protein>5.0 mg/L,total IgE 2.0×10^(6) IU/L,and erythrocyte sedimentation rate 56 mm/1 h.No abnormalities were found in other tests.Pathological examination showed that a small to medium amount of lymphocyte infiltration distributed around the full-layer vessels of the dermis;several nodules were scattered in the subcutaneous adipose tissue layer,with histocytes in the center,some of which were epithelioid,surrounded by a few lymphocytes and neutrophils,and Periodic acid-Schiff stain and acid-fast stain were negative.The patient′s symptoms were improved after discontinuing ixekizumab and receiving 2 weeks of anti-allergy,anti-inflammatory,and topical glucocorticoid therapy.At a 2-month of follow-up,Behcet′s disease symptoms and eczema-like rash did not recur.