Benedix Frauke, Schilling Melany, Schaller Martin, Röcken Martin, Biedermann Tilo
Department of Dermatology, Eberhard Karls University, Tübingen, Germany.
Acta Derm Venereol. 2008;88(5):491-4. doi: 10.2340/00015555-0519.
A 23-year-old woman presented with recurrent herpetiform vesicles of the lower lip, but all diagnostic measures for herpes virus infection including herpes viridae specific PCR were negative. Medical history revealed that she also had chronic recurrent vulvovaginal candidiasis, which had been treated with various regimes, including repetitive applications of fluconazole. Consequently, fluconazole-induced fixed drug eruption was suspected, but skin tests performed with fluconazole remained with-out response. Consecutive repeated oral provocation tests with fluconazole were carried out and resulted in the development of burning herpetiform vesicles of the lower lip. Histopathology revealed a subepidermal and superficial perivascular infiltrate, basal vacuolated and apoptotic keratinocytes, intra-epidermal lymphocytes and intra-epidermal multilocular vesicles. Together with the clinical history and picture, fluconazole-induced fixed drug eruption mimicking labial herpes simplex virus infection was diagnosed. Oral provocation tests with an alternative systemic antifungal treatment, itraconazole, were well tolerated, systemic therapy with itraconazole was initiated, and no further labial vesicles developed.
一名23岁女性出现下唇反复出现疱疹样水疱，但包括疱疹病毒特异性PCR在内的所有疱疹病毒感染诊断措施均为阴性。病史显示她还患有慢性复发性外阴阴道念珠菌病，曾接受过包括反复应用氟康唑在内的各种治疗方案。因此，怀疑是氟康唑引起的固定性药疹，但用氟康唑进行的皮肤试验无反应。连续多次口服氟康唑激发试验，结果导致下唇出现灼痛性疱疹样水疱。组织病理学显示表皮下和浅层血管周围浸润、基底空泡化和凋亡的角质形成细胞、表皮内淋巴细胞和表皮内多房性水疱。结合临床病史和表现，诊断为氟康唑引起的固定性药疹，酷似唇单纯疱疹病毒感染。用另一种全身性抗真菌治疗药物伊曲康唑进行口服激发试验耐受性良好，遂开始用伊曲康唑进行全身治疗，此后未再出现唇部水疱。
