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首页> 外文期刊>Cureus. >Steroid-induced Diabetes Complicating Treatment of Epidermolysis Bullosa Acquisita: A Preventable Treatment Complication Stresses the Importance of Primary Care Follow-up
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Steroid-induced Diabetes Complicating Treatment of Epidermolysis Bullosa Acquisita: A Preventable Treatment Complication Stresses the Importance of Primary Care Follow-up

机译：类固醇诱导的糖尿病并发表皮松解的复杂治疗：可预防的治疗并发症强调了初级保健随访的重要性

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Epidermolysis bullosa acquisita is a rare autoimmune bullous disease involving the skin and mucosa, most commonly treated with systemic corticosteroids. This case illustrates the importance of counseling patients on medication side effects and ensuring close physician follow-up during an extended course of steroids. A 46-year-old man presented to the emergency department with weakness, fatigue, dizziness?and polyuria in the setting of eight weeks of prednisone therapy for a flare-up of his bullous disease. Labs were significant for a blood glucose of 786 mg/dL, negative urine ketones, a normal anion gap, and an acute kidney injury. Blood glucose improved to 413 mg/dL after initial treatment with fluid and insulin. The patient was admitted and acute kidney injury resolved. He remained hyperglycemic despite his adjusted prednisone taper and corrective scale insulin, so basal and scheduled, pre-prandial insulins were added. After discharge, he was bridged to steroid-sparing therapy (rituximab). Physicians should counsel patients with epidermolysis bullosa acquisita about the risks of steroid-induced diabetes mellitus and its associated complications including hyperglycemic hyperosmolar state and diabetic ketoacidosis. Primary care physicians should screen for hyperglycemia during therapy?and consider alternative treatments when necessary.
机译：大疱表皮松解症是一种罕见的自身免疫性大疱性疾病，涉及皮肤和粘膜，最常用全身性皮质类固醇激素治疗。这个案例说明了就药物副作用向患者提供咨询并确保在类固醇治疗过程中密切随访医生的重要性。一名46岁的男子因泼尼松治疗八周而爆发大疱性疾病，因虚弱，疲倦，头晕和多尿症出现在急诊科。实验室的血糖水平为786 mg / dL，尿酮阴性，阴离子间隙正常，急性肾损伤显着。初次使用液体和胰岛素治疗后，血糖提高至413 mg / dL。该患者入院，急性肾损伤得以解决。尽管他调整了泼尼松的锥度和矫正规模的胰岛素，但他仍保持高血糖状态，因此增加了基础和预定的餐前胰岛素。出院后，他被接受了类固醇保存疗法（利妥昔单抗）。医生应向大疱性表皮松解症患者咨询类固醇诱导的糖尿病及其相关并发症（包括高血糖高渗状态和糖尿病酮症酸中毒）的风险。初级保健医生应在治疗期间筛查高血糖症，并在必要时考虑其他治疗方法。

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