Emory Saint Joseph's Hospital, Atlanta, GA, USA.
Emory University School of Medicine, Division of Hospital Medicine, Atlanta, GA, USA.
J Investig Med High Impact Case Rep. 2022 Jan-Dec;10:23247096221117785. doi: 10.1177/23247096221117785.
Adverse cutaneous reactions to medications are not uncommon and may resemble viral infection and vice versa, complicating diagnosis. We describe the case of a 79-year-old male with cholangiocarcinoma with liver and presumed lung metastasis who presented with abdominal pain and was admitted with ileitis with partial small bowel obstruction. He had a widespread papulovesicular rash with hemorrhagic center, mostly on his face, chest, and back. The rash was initially thought to be a drug eruption, but was eventually diagnosed via dermatopathological examination as disseminated varicella zoster virus (VZV) infection. Steroid treatment was discontinued, and airborne precautions were initiated. Polymerase chain reaction for VZV was obtained and intravenous acyclovir treatment was begun. This case of VZV, initially suspected to be an adverse drug reaction, highlights the importance of early identification of a highly infectious lesion and the importance of early infection control measures, given the implications of exposure to VZV for health care personnel.
药物引起的皮肤不良反应并不少见，其表现可能类似于病毒感染，反之亦然，这使得诊断变得复杂。我们描述了一例 79 岁男性，患有胆管癌伴肝和疑似肺转移，因腹痛就诊，入院时伴有回肠炎伴部分小肠梗阻。他的面部、胸部和背部有广泛的疱疹性水疱性皮疹，伴有出血中心。最初认为是药物疹，但最终通过皮肤病理检查诊断为播散性水痘带状疱疹病毒（VZV）感染。停用了类固醇治疗，并采取了空气传播预防措施。进行了 VZV 的聚合酶链反应检测，并开始静脉用阿昔洛韦治疗。最初怀疑是药物不良反应的 VZV 感染，强调了早期识别高度传染性病变的重要性，以及鉴于接触 VZV 对医护人员的影响，早期采取感染控制措施的重要性。
