Gavin Meredith, Sharp Leigha, Walker Kendra, Behrens Emily, Akin Russell, Stetson Cloyce L
School of Medicine, Texas Tech University Health Sciences CenterLubbockTexas.
Department of Dermatology, Texas Tech University Health Sciences CenterLubbockTexas.
Proc (Bayl Univ Med Cent). 2019 Aug 7;32(4):601-602. doi: 10.1080/08998280.2019.1644147. eCollection 2019 Oct.
A 59-year-old woman with end-stage renal disease presented for suspected Stevens-Johnson syndrome that was ultimately diagnosed as generalized bullous fixed drug eruption (GBFDE) secondary to the administration of iodinated nonpolar radiocontrast. The patient had three previous episodes of a generalized bullous eruption after a thrombectomy, fistulogram, and an arteriovenous fistula revision, all requiring radiocontrast administration. Biopsies taken after previous eruptions demonstrated full-thickness epidermal necrosis, and she was diagnosed with Stevens-Johnson syndrome thought to be due to allopurinol. However, against medical advice she continued taking allopurinol and remained asymptomatic until the current presentation. Based on the clinical appearance and time frame of the eruptions, the patient was diagnosed with GBFDE due to radiocontrast. GBFDE, a rare variant of a fixed drug eruption, can be misdiagnosed as Stevens-Johnson syndrome due to their overlapping features of drug-induced whole-body blisters and variable degrees of epidermal necrosis.
一名患有终末期肾病的59岁女性因疑似史蒂文斯-约翰逊综合征就诊，最终被诊断为因使用碘化非极性放射性造影剂继发的全身性大疱性固定性药疹（GBFDE）。该患者在之前的血栓切除术、瘘管造影和动静脉瘘修复术后曾有过三次全身性大疱性皮疹发作，所有这些都需要使用放射性造影剂。之前皮疹发作后进行的活检显示全层表皮坏死，她被诊断为史蒂文斯-约翰逊综合征，认为是由别嘌醇引起的。然而，她违背医嘱继续服用别嘌醇，直到此次就诊前一直无症状。根据皮疹的临床表现和发作时间，该患者被诊断为因放射性造影剂导致的GBFDE。GBFDE是固定性药疹的一种罕见变体，由于其药物性全身水疱和不同程度表皮坏死的重叠特征，可能会被误诊为史蒂文斯-约翰逊综合征。
