妊娠性类天疱疮一例
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摘要
27岁女性患者,躯干、四肢红斑伴痒4个月余,加重并出现水疱1 d。患者4个多月前(妊娠20~+周)四肢出现红斑、风团伴剧烈瘙痒,后逐渐扩散至躯干。1 d前(妊娠39~+5周)患者自然分娩后红斑加重,四肢出现张力性水疱、大疱,伴痛痒。体格检查:四肢、躯干大片红斑、丘疹,双上肢及股内侧红斑上见张力性水疱、大疱。红斑处组织病理示:表皮下裂隙性疱,真皮浅层血管扩张,血管周围炎性细胞浸润,有较多嗜酸粒细胞。直接免疫荧光示:C3、IgG在基膜带呈线状沉积。诊断:妊娠疱疹。未予治疗,病情逐渐好转,分娩后第20天全身水疱消退,未见新发皮损。
A 27-year-old female patient suffered from erythema on the trunk and four extremities with itching for over four months, aggravated and presented with blisters for one day. More than 4 months ago(20~+ weeks of gestation), the patient experienced erythema and wheal with intense pruritus on the four extremities, and then gradually spread to the trunk. On June 18, 2017(39~+5 weeks of gestation), the patient had a normal labor, and the erythema became exacerbated on the next day, tension blisters and bullae appeared on the four extremities accompanied by pain and itching. Physical examination: Large erythematous patches and papules could be visualized on the four extremities and trunk, and tension blisters and bullae were visible on both the upper extremities and medial femur. Histopathology of erythema showed subepidermal fissure blisters, dilatation of superficial dermal vessels, infiltration of inflammatory cells around blood vessels with more eosinophils. Direct immunofluorescence showed that C3 and IgG were linearly deposited in basement membrane zone. The patient was diagnosed with herpes gestationis. Without treatment, the condition of the patient improved gradually. On the 20 th day after delivery, the whole body blisters subsided and no new skin lesions were found.
A 27-year-old female patient suffered from erythema on the trunk and four extremities with itching for over four months, aggravated and presented with blisters for one day. More than 4 months ago(20~+ weeks of gestation), the patient experienced erythema and wheal with intense pruritus on the four extremities, and then gradually spread to the trunk. On June 18, 2017(39~+5 weeks of gestation), the patient had a normal labor, and the erythema became exacerbated on the next day, tension blisters and bullae appeared on the four extremities accompanied by pain and itching. Physical examination: Large erythematous patches and papules could be visualized on the four extremities and trunk, and tension blisters and bullae were visible on both the upper extremities and medial femur. Histopathology of erythema showed subepidermal fissure blisters, dilatation of superficial dermal vessels, infiltration of inflammatory cells around blood vessels with more eosinophils. Direct immunofluorescence showed that C3 and IgG were linearly deposited in basement membrane zone. The patient was diagnosed with herpes gestationis. Without treatment, the condition of the patient improved gradually. On the 20 th day after delivery, the whole body blisters subsided and no new skin lesions were found.
引文
[1]Singla A,Shree S,Mehta S.Pregnancy with pemphigoid gestationis:a rare entity[J].J Clin Diagn Res,2016,10(7):QD06-07.
[2]Cabral R,Teixeira V,Brinca A,et al.Case for diagnosis.pemphigoid gestationis[J].An Bras Dermatol,2014,89(1):167-168.
[3]Podolec-Rubi?M,Wo?ek M,Brzewski P,et al.Suspicion of pulmonary embolism during treatment of pemphigoid gestationis[J].Postepy Dermatol Alergol,2013,30(1):59-61.
[4]Hallaji Z,Mortazavi H,Ashtari S,et al.Pemphigoid gestationis:clinical and histologic features of twenty-three patients[J].Int JWomens Dermatol,2017,3(2):86-90.
[5]Barnadas MA,Rubiales MV,González MJ,et al.Enzyme-linked immunosorbent assay(ELISA)and indirect immunofluorescence testing in a bullous pemphigoid and pemphigoid gestationis[J].Int JDermatol,2008,47(12):1245-1249.
[6]Lipozen?i?J,Ljubojevic S,Bukvi?-Mokos Z.Pemphigoid gestationis[J].Clin Dermatol,2012,30(1):51-55.
[7]Ambros-Rudolph CM.Dermatoses of pregnancy-clues to diagnosis,fetal risk and therapy[J].Ann Dermatol,2011,23(3):265-275.
[8]Chi CC,Wang SH,Charles-Holmes R,et al.Pemphigoid gestationis:early onset and blister formation are associated with adverse pregnancy outcomes[J].Br J Dermatol,2009,160(6):1222-1228.
[2]Cabral R,Teixeira V,Brinca A,et al.Case for diagnosis.pemphigoid gestationis[J].An Bras Dermatol,2014,89(1):167-168.
[3]Podolec-Rubi?M,Wo?ek M,Brzewski P,et al.Suspicion of pulmonary embolism during treatment of pemphigoid gestationis[J].Postepy Dermatol Alergol,2013,30(1):59-61.
[4]Hallaji Z,Mortazavi H,Ashtari S,et al.Pemphigoid gestationis:clinical and histologic features of twenty-three patients[J].Int JWomens Dermatol,2017,3(2):86-90.
[5]Barnadas MA,Rubiales MV,González MJ,et al.Enzyme-linked immunosorbent assay(ELISA)and indirect immunofluorescence testing in a bullous pemphigoid and pemphigoid gestationis[J].Int JDermatol,2008,47(12):1245-1249.
[6]Lipozen?i?J,Ljubojevic S,Bukvi?-Mokos Z.Pemphigoid gestationis[J].Clin Dermatol,2012,30(1):51-55.
[7]Ambros-Rudolph CM.Dermatoses of pregnancy-clues to diagnosis,fetal risk and therapy[J].Ann Dermatol,2011,23(3):265-275.
[8]Chi CC,Wang SH,Charles-Holmes R,et al.Pemphigoid gestationis:early onset and blister formation are associated with adverse pregnancy outcomes[J].Br J Dermatol,2009,160(6):1222-1228.