Levofloxacin-Associated Bullous Pemphigoid in a Hemodialysis Patient After Kidney Transplant Failure.
Levofloxacin-Associated Bullous Pemphigoid in a Hemodialysis Patient After Kidney Transplant Failure.
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DOI：
10.12659/ajcr.938476
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发表时间：
2022-12-29
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患者：女，27岁 最终诊断：左氧氟沙星相关大疱性类天疱疮 症状：大疱性皮疹加重 药物：- 临床程序：- 专业：皮肤科·肾脏科 需要透析的终末期肾病（ESRD）患者可能会出现各种皮肤状况，如瘙痒、干燥、皮肤感染和自身免疫反应。大疱性类天疱疮（BP）是一种自身免疫性大疱性疾病，发病率不断上升。它可以由超过90种药物引起，但左氧氟沙星在血液透析患者中引起的血压尚未报道。这份报告是一个27岁的女性与终末期肾病血液透析谁开发BP后左氧氟沙星治疗。一名27岁女性，肾移植失败后进行血液透析，入院前1.5个月开始使用左氧氟沙星治疗疑似尿路感染。左氧氟沙星治疗3周后，她的尿路感染症状得到改善，但出现严重皮疹，全身出现进行性大疱，累及面部。全面检查显示半桥粒抗原BP 180（116 RU/mL）显著升高，人盐裂皮肤基质上的皮肤间接免疫荧光对具有表皮模式的血清基底膜区IgG呈阳性。皮肤活检直接免疫荧光染色显示连续线性C3沉积沿基底膜区沿着。泼尼松每日60 mg，开始逐渐减量。随访3个多月，患者不再出现新皮疹。据我们所知，这是第一例左氧氟沙星诱导的血压在接受血液透析的患者。本报告强调了认识透析患者与终末期肾病相关的皮肤反应、通过活检和组织病理学进行正确诊断以及正确和及时管理的重要性。
Patient: Female, 27-year-old Final Diagnosis: Levofloxacin-associated bullous pemphigoid Symptoms: Worsening bullous rash Medication:— Clinical Procedure: — Specialty: Dermatology • Nephrology Rare disease Patients with end-stage renal disease (ESRD) who require dialysis can develop a variety of skin conditions, such as pruritus, xerosis, skin infections, and autoimmune reactions. Bullous pemphigoid (BP) is an autoimmune bullous disorder with an increasing incidence. It can be caused by over 90 medications, but levofloxacin-induced BP in hemodialysis patients has not yet been reported. This report is of a 27-year-old woman with ESRD on hemodialysis who developed BP after levofloxacin treatment. A 27-year-old woman with hemodialysis after kidney transplantation failure was started with levofloxacin for suspected urinary tract infection 1.5 months prior to admission. Her urinary tract infection symptoms were improved after 3 weeks of levofloxacin treatment, but a serious rash developed, presenting with progressive bullous throughout the body and facial involvement. A thorough workup showed a remarkably elevated hemidesmosomal antigen, BP180 (116 RU/mL), and cutaneous indirect immunofluorescence on human salt-split skin substrate was positive for serum basement membrane zone IgG with an epidermal pattern. Skin biopsy direct immunofluorescence staining showed continuous linear C3 deposition along the basement membrane zone. Prednisone 60 mg daily was started with a taper schedule. She no longer had new skin rash during a follow-up of over 3 months. To the best of our knowledge, this is the first case of levofloxacin-induced BP in a patient undergoing hemodialysis. This report highlights the importance of recognizing skin reactions associated with ESRD in dialysis patients, the correct diagnosis by biopsy and histopathology, and the correct and timely management.