[酷似药物超敏反应伴嗜酸性粒细胞增多和系统症状（DRESS）的胆固醇结晶栓塞]
[Cholesterol crystal embolism mimicking a DRESS].
作者信息
Dumas M, Flipo R, Blum L, Jouzel C, Brochériou I, Begon E
机构信息
Service de dermatologie, hôpital René Dubos-Pontoise, 6, avenue de l'île de France, 95300 Pontoise, France.
Service de dermatologie, hôpital René Dubos-Pontoise, 6, avenue de l'île de France, 95300 Pontoise, France.
出版信息
Rev Med Interne. 2020 Apr;41(4):275-278. doi: 10.1016/j.revmed.2020.01.007. Epub 2020 Feb 20.
INTRODUCTION
Clinical presentation of cholesterol crystal embolism (CCE) can be dermatologic when cholesterol crystals become lodged in small cutaneous arteries resulting in ischemia. We report a case of CCE with erythroderma misleading to a diagnostic of drug reaction with eosinophilia and systemic symptoms (DRESS).
CASE REPORT
A 66 year-old woman presented with erythroderma few months after initiation of allopurinol. Acute renal failure was present with elevation in plasma creatinine concentration (523μmol/L) and hypereosinophilia (HE) (5666/mm). Finally, the REGISCAR score helped to rule out DRESS diagnostic. Past blood-count tests were analyzed revealing chronic HE present before allopurinol initiation. Renal biopsy identified CCE.
CONCLUSION
This case is the first to report a DRESS like presentation of CCE. Clinical findings are secondary to HE and not to occlusion of cutaneous arteries.
引言
当胆固醇结晶阻塞小的皮肤动脉导致缺血时，胆固醇结晶栓塞（CCE）的临床表现可能为皮肤症状。我们报告一例CCE病例，其红皮病表现误导诊断为伴有嗜酸性粒细胞增多和全身症状的药物反应（DRESS）。
病例报告
一名66岁女性在开始使用别嘌醇几个月后出现红皮病。存在急性肾衰竭，血浆肌酐浓度升高（523μmol/L）和嗜酸性粒细胞增多（HE）（5666/mm）。最终，REGISCAR评分有助于排除DRESS诊断。分析既往血常规检查发现，在开始使用别嘌醇之前就存在慢性HE。肾活检确诊为CCE。
结论
本病例是首例报告CCE表现类似DRESS的病例。临床发现是由HE引起，而非皮肤动脉阻塞所致。
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