Sarwar Haroon, Espinoza Luis R, McGrath Hugh, Yaqub Zunera, Cucurull Elena
Section of Rheumatology, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.
J Clin Rheumatol. 2004 Oct;10(5):275-6. doi: 10.1097/01.rhu.0000141510.25929.d6.
A 52-year-old patient with early diffuse scleroderma (Scl) developed scleroderma renal crisis (SRC) following exposure to topical steroid cream. She had applied a larger-than-prescribed quantity of triamcinolone acetonide 0.1% cream all over her body for 3 months, the absorption of the cream being the equivalent of 7.5 mg of oral prednisone per day. Her SRC was subsequently managed successfully with aggressive antihypertensive therapy and hemodialysis, and she was discharged home. High-dose corticosteroids (CS) have long been implicated in the development of SRC, but topical and low-dose CS until now have not. In our opinion, low-dose CS and a predisposing clinical setting appeared sufficient to provoke SRC and may broaden the proscription against CS in Scl.
一名52岁的早期弥漫性硬皮病（Scl）患者在使用外用类固醇乳膏后发生了硬皮病肾危象（SRC）。她在全身涂抹了超过规定剂量的0.1%曲安奈德乳膏，持续3个月，该乳膏的吸收量相当于每天7.5毫克口服泼尼松。随后，她通过积极的抗高血压治疗和血液透析成功控制了SRC，并出院回家。长期以来，高剂量皮质类固醇（CS）一直被认为与SRC的发生有关，但迄今为止，局部和低剂量CS尚未被证实有此关联。我们认为，低剂量CS和易感的临床背景似乎足以引发SRC，这可能会扩大Scl中对CS的禁忌范围。
