Demirci Goktug, Demirci Gulsen Tukenmez, Gulkilik Gokhan
Department of Ophthalmology, Duzce Goverment Hospital, Duzce, Turkey.
Case Rep Ophthalmol. 2010 May 12;1(1):1-4. doi: 10.1159/000313788.
To report a first case of bullous pemphigoid (BP) following intravenous fluorescein for fundus angiography. Clinical Features: A 70-year-old male patient was admitted to the intensive care unit with BP and sepsis. He reported a history of fundus fluorescein angiography with a pre-diagnosis of senile macular degeneration 2 months prior to presentation. At that time, fluorescein extravasated at the antecubital region. Following the procedure, pruritus and erythema began at the wrists bilaterally, and quickly spread to the entire body. The patient also reported a history of allergy to human albumin solution (Plamasteril(R); Abbott) 15 years before, during bypass surgery. On dermatologic examination, erythematous patches were present on the scalp, chest and anogenital region. Vesicles and bullous lesions were present on upper and lower extremities. On day 2 of hospitalization, tense bullae appeared on the upper and lower extremities. The patient was treated with oral methylprednisolone 48 mg (Prednol(R); Mustafa Nevzat), topical clobetasol dipropionate 0.05% cream (Dermovate(R); Glaxo SmithKline), and topical 4% urea lotion (Excipial Lipo(R); Orva) for presumptive bullous pemphigoid. Skin punch biopsy provided tissue for histopathology, direct immunofluorescence examination, and salt extraction, which were all consistent with BP. After 1 month, the patient was transferred to the intensive care unit with sepsis secondary to urinary tract infection; he died 2 weeks later from sepsis and cardiac failure. CONCLUSIONS: To our knowledge, this is the first reported case of BP following fundus fluorescein angiography in a patient with known human albumin solution allergy. Consideration should be made to avoid fluorescein angiography, change administration route, or premedicate with antihistamines in patients with known human albumin solution allergy. The association between fundus fluorescein angiography and BP should be further investigated.
报告首例因眼底血管造影静脉注射荧光素后发生大疱性类天疱疮（BP）的病例。临床特征：一名70岁男性患者因BP和脓毒症入住重症监护病房。他报告在就诊前2个月有眼底荧光素血管造影史，初步诊断为老年性黄斑变性。当时，荧光素在前臂区域渗漏。检查后，双侧手腕开始出现瘙痒和红斑，并迅速蔓延至全身。患者还报告15年前在搭桥手术期间对人白蛋白溶液（Plamasteril®；雅培公司）过敏。皮肤科检查发现，头皮、胸部和肛门生殖器区域有红斑。上肢和下肢出现水疱和大疱性皮损。住院第2天，上肢和下肢出现紧张性大疱。给予患者口服甲泼尼龙48毫克（Prednol®；穆斯塔法·内夫扎特公司）、外用0.05%丙酸氯倍他索乳膏（Dermovate®；葛兰素史克公司）和外用4%尿素洗剂（Excipial Lipo®；奥尔瓦公司），拟诊为大疱性类天疱疮。皮肤打孔活检提供了用于组织病理学、直接免疫荧光检查和盐提取的组织，结果均符合BP。1个月后，患者因尿路感染继发脓毒症转入重症监护病房；2周后因脓毒症和心力衰竭死亡。结论：据我们所知，这是首例已知对人白蛋白溶液过敏的患者在眼底荧光素血管造影后发生BP的报道病例。对于已知对人白蛋白溶液过敏的患者，应考虑避免进行荧光素血管造影、改变给药途径或使用抗组胺药进行预处理。眼底荧光素血管造影与BP之间的关联应进一步研究。
