The interstitial granulomatous drug reaction: a distinctive clinical and pathological entity
The interstitial granulomatous drug reaction: a distinctive clinical and pathological entity
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DOI：
10.1111/j.1600-0560.1998.tb01693.x
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发表时间：
1998-02-01
影响因子：
1.7
通讯作者：
Schapiro, BL
中科院分区：
文献类型：
--
作者：
Magro, CM;Crowson, AN;Schapiro, BL
我们报告了20例药物治疗与间质组织细胞浸润相关的患者，其胶原和弹性纤维变性类似于环状肉芽肿（GA）的早期病变。大多数患者具有可重现的临床表现，包括黄色至紫色、非斑块性斑块，通常具有环形模式，主要涉及手臂、大腿内侧和擦破区的内部。最常见的临床鉴别诊断包括皮肤T细胞淋巴瘤、中心性环状红斑（EAC）、GA和红斑狼疮。仅3例病例疑似药物反应。涉及的药物类别包括钙通道阻滞剂、血管紧张素转换酶抑制剂、β受体阻滞剂、降脂药、抗组胺药、抗惊厥药和抗抑郁药。患者经常使用两种或两种以上的药物，所有这些药物都与皮肤的假淋巴瘤浸润有关，其假定基础是免疫功能的医源性扰动。定义的组织形态学是淋巴细胞和组织细胞弥漫性浸润结缔组织，伴有胶原和弹性纤维碎片，与空泡性界面皮炎一致。10例显示中间型和转化型淋巴细胞，其核深染，呈卷曲状，排列于真皮内或沿着真皮表皮交界处，具有不同的向表皮性。在15例停用相关药物的患者中，病变消退。我们建议将这种新的皮肤反应模式命名为间质性肉芽肿药物反应。
We present 20 patients in whom drug therapy was associated With interstitial histiocytic infiltrates with variable degeneration of collagen and elastic fibers mimicking early lesions of granuloma annulare (GA). Most patients had a reproducible clinical presentation comprising erythematous-to-violaceous, nonpruritic plaques, often vith an annular pattern, predominantly involving inner aspects of the arms, medial thighs and intertriginous areas. The most frequent clinical differential diagnoses included cutaneous T cell lymphoma, erythema annulare centrifigum(EAC), GA, and lupus erythematosus. A drug reaction was suspected in only 3 cases. The implicated drug classes included calcium channel blockers, angiotensin converting enzyme inhibitors, betablockers, lipid-lowering agents, antihistamines, anticonvulsants and antidepressants. Patients were often on two or more of these drugs; all have been associated with pseudolymphomatous infiltrates of the skin, the presumptive basis of which is iatrogenic pertubation of immune function. The defining histomorphology was diffuse infiltration of the interstitium by lymphocytes and histiocytes with piecemeal fragmentation of collagen and elastic fibers in concert with a vacuolar interface dermatitis. Ten cases showed intermediate and transformed lymphocytes with hyperchromatic convoluted nuclei disposed interstitially within the dermis or along the dermoepidermal junction with variable epidermotropism. In the 15 patients who discontinued the implicated drug, lesional resolution occurred. We propose the designations interstitial granulomatous drug reaction for this novel cutaneous reaction pattern.