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首页> 外文期刊>The Internet Journal of Anesthesiology >Celecoxib-Induced Bullous Pemphigoid: Report Of The First Case
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Celecoxib-Induced Bullous Pemphigoid: Report Of The First Case

机译：塞来昔布诱导的大疱性天疱疮：首例病例报告

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A 72-year-old woman developed a bullous eruption affecting her oral mucous membranes, hands, and feet. A skin biopsy revealed subepidermal bullae with lymphocytes. Immunofluorescence showed heavy IgG and C3 deposition at the basement membrane zone. Bullous pemphigoid was diagnosed on the basis of clinical, histopathologic, and immunofluorescence findings. The bullae developed after recent ingestion of celecoxib and subsided soon after discontinuation. We believe this case represents the first reported case of celecoxib-induced bullous pemphigoid. Introduction Bullous pemphigoid (BP) is the most common autoimmune blistering skin disease and occurs with increasing frequency in elderly patients. The cause is usually unknown, but there have been cases attributed to drugs. In drug-induced BP, the clinical, histologic, and immunopathologic features are identical to those in idiopathic disease, but induced by systemic ingestion or local use of certain drugs.[1] This is the first reported case of celecoxib-induced BP. Case Report A 72-year-old woman with a past medical history significant for recurrent colon cancer was admitted for worsening mucositis and bullous eruption of her toes, fingers, and mucous membranes for two weeks. Approximately two years prior to presentation, she had been diagnosed with colon cancer that was treated with sigmoid resection with negative lymph nodes. She subsequently received the first two courses of 5-fluorouracil and leucovorin, but chemotherapy was discontinued because of severe toxicity including mucositis, fatigue, and dehydration. She continued to receive regular follow-up with no recurrence until about six months prior to presentation, when she began noticing bloody stools. An elevated CEA two months later was followed by a negative colonoscopy. However repeat colonoscopy revealed an obstruction which was deemed unresectable, and capecitabine (1500 mg at night for two weeks) along with celecoxib (200 mg twice a day) was chosen for chemotherapy. She tolerated the first cycle complaining only of gum soreness without mucositis or new skin lesions. After her second cycle, she developed extensive mucositic lesions and erythema of her soft palate, buccal mucosa, and lower lip. About one week later, she developed tense blisters on her toes and fingers as well as a few blisters in her oropharynx. (Figure 1) Her chemotherapy was held in addition to all nonessential medications. With discontinuation of her medications and supportive care, the mucositis and bullous lesions improved.
机译：一名72岁的妇女发生大疱性喷发，影响了她的口腔粘膜，手和脚。皮肤活检显示表皮下大疱和淋巴细胞。免疫荧光显示基底膜区有大量IgG和C3沉积。大疱性天疱疮是根据临床，组织病理学和免疫荧光检查结果诊断的。大疱在最近摄入塞来昔布后出现，并在停药后不久消退。我们认为该病例是塞来昔布诱导的大疱性类天疱疮的首例报道病例。简介大疱性类天疱疮（BP）是最常见的自身免疫性水疱性皮肤病，在老年患者中发病率越来越高。原因通常是未知的，但有一些病例归因于毒品。在药物诱发的BP中，其临床，组织学和免疫病理学特征与特发性疾病相同，但是通过全身性摄入或局部使用某些药物引起的。[1]这是塞来昔布诱导的BP的首例报道。病例报告一名72岁的女性，过去的病史对复发性结肠癌有重要意义，因其粘膜炎加重，脚趾，手指和粘膜大疱性喷发持续了两周而入院。就诊前大约两年，她被诊断出患有结肠癌，接受了乙状结肠切除，淋巴结阴性。她随后接受了5-氟尿嘧啶和亚叶酸的前两个疗程，但由于包括粘膜炎，疲劳和脱水在内的严重毒性而终止了化疗。她继续接受定期随访，直到复发为止，直到就诊前六个月才开始注意到便血。两个月后CEA升高，结肠镜检查阴性。然而，重复的结肠镜检查发现被认为无法切除的阻塞，因此选择了卡培他滨（夜间1500 mg，持续两周）和塞来昔布（200 mg，每天两次）进行化疗。她耐受第一个周期，只抱怨牙龈酸痛，没有粘膜炎或新的皮肤病变。在第二个周期后，她的软extensive，颊粘膜和下唇出现了广泛的粘液性病变和红斑。大约一周后，她的脚趾和手指上出现了水泡，口咽部也出现了水泡。 （图1）除所有非必需药物外，还进行了化疗。随着她停止药物治疗和支持治疗，粘膜炎和大疱性病变得以改善。

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