Injection site vasculitis in a patient receiving interferon alfa for chronic hepatitis C.
Injection site vasculitis in a patient receiving interferon alfa for chronic hepatitis C.
复制标题
接受干扰素α治疗慢性丙型肝炎的患者出现注射部位血管炎。
DOI：
10.1016/s0190-9622(97)70223-8
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发表时间：
1997
影响因子：
13.8
通讯作者：
R. Soloway
中科院分区：
文献类型：
--
作者：
M. Christian;D. Diven;R. Sánchez;R. Soloway
IFN-γ引起的皮肤副作用很多。注射部位红斑和硬结是最常见的皮肤反应。1脱发、唇疱疹加重、瘙痒、四肢和躯干点状毛细血管扩张、银屑病发作、既存银屑病发作、嗜酸性筋膜炎、副肿瘤性天疱疮和全身水肿已收载于近期综述中。3此外，还描述了注射部位溃疡，显示溃疡区域下方的血管增生和纤维组织增生。3皮下注射IFN-13-1b后也有注射部位溃疡的报道。活检标本显示血管周围淋巴组织细胞浸润和较深血管血栓形成，但没有白细胞破碎性血管炎的证据。4其它对IFN-α的注射部位反应包括疼痛性结节伴水疱5和局部硬结伴坏死。6结节的组织学检查显示含有中性粒细胞的角膜下囊泡、表皮海绵状增生、空泡基底层改变和血管周围淋巴细胞浸润（认为与固定药疹一致），5而硬结显示真皮和皮下脂肪中的静脉血管血栓形成。6例其他报告的皮肤反应包括接触性过敏、7例银屑病关节炎、8例口腔溃疡、2例口干症、9例大疱性皮疹、1例扁平苔藓加重，n 1例”血管炎性病变”病例报告（未经活组织检查证实），导致在肌肉内IFN-α治疗睾丸癌后1周指尖脱落12;然而，据我们所知，还没有注射部位血管炎的报道。原发性混合型冷球蛋白血症和丙型肝炎之间存在很强的联系。根据最近的一份报告，大多数原发性混合型冷球蛋白血症患者也患有丙型肝炎。原发性混合型冷球蛋白血症以血管炎、关节痛、不适和肾小球肾炎为特征。2组织学上，存在白细胞破碎性血管炎的典型表现，有时在真皮血管中伴有透明血栓。13 IFN-α对丙型肝炎相关的冷球蛋白血症有效，据报道氨基转移酶水平14得到改善，皮肤血管炎得到清除。虽然我们的病人可能有丙型肝炎相关的冷球蛋白血症引起的血管炎，但有几个方面的表现与此相反。首先，大腿病变的优势是与原发性混合性冷球蛋白血症相关的血管炎的特征，其中通常有更多的远端病变。
DISCUSSIONThe cutaneous side effects attributed to IFN-o~ are numerous. Injection site erythema and induration are the most common cutaneous reactions. 1 Alopecia, exacerbation of herpes labialis, pruritus, punctate telangiectases on the extremities and trunk, onset of psoriasis, flaring of preexisting psoriasis, eosinophilic fasciitis, paraneoplastic pemphigus, and anasarca were listed in a recent review. 3 In addition, injection site ulcerations that showed vascular proliferation and fibroplasia below areas of ulceration have been described. 3 Injection site ulcerations have also been reported after subcutaneous administration of IFN-13-1b. Biopsy specimens revealed a perivascular lymphohistiocytic infiltrate and thrombosis of deeper vessels, but no evidence of leukocytoclastic vasculitis. 4 Other injection-site reactions to IFN-c~ include painful nodules with vesiculation 5 and localized induration with necrosis. 6 Histologic examination of the nodules revealed a subcorneal vesicle containing neutrophils, epidermal spongiosis, vacuolar basal layer change, and a perivascular lymphocytic infiltrate (thought to be consistent with a fixed drug eruption), 5 whereas the induration showed thrombosis of the venous vessels in the dermis and subcutaneous fat. 6 Other reported cutaneous reactions include contact allergy, 7 psoriatic arthritis, 8 mouth ulcers, 2 xerostomia, 9 a bullous eruption, 1 and exacerbation of lichen planus, n A case report of a" vascufitic lesion"(not confirmed by biopsy) on a patient's finger that resulted in sloughing of the fingertip 1 week after intramuscular IFN-a therapy for testicular cancer has been published12; however, to our knowledge, no reports of injection site vascufitis have been made.A strong association between essential mixed cryoglobulinemia and hepatitis C exists. According to a recent report, the majority of patients with essential mixed cryoglobulinemia also have hepatitis C. 13 Essential mixed cryoglobulinemia is characterized by vasculitis, arthralgias, malaise, and often glomerulonephritis. 2 Histologically, the typical findings of leukocytoclastic vasculitis are present, sometimes in conjunction with hyaline thrombi in dermal vessels. 13 IFN-a is efficacious for hepatitis C-associated cryoglobulinemia, with improvement reported in aminotransferase enzyme levels 14 and clearing of cutaneous vasculitis. 2 Although our patient could have vasculitis resulting from hepatitis C-associated cryoglobulinemia, several components of the presentation argue against this. First, the predominance of lesions on the thighs is uncharacteristic of vasculitis associated with essential mixed cryoglobulinemia, in which there is usually more distal predom-