复方新诺明引起的大疱性食管病变：一种免疫介导的过程？

Bullous esophageal lesions due to cotrimoxazole: an immune-mediated process?

作者信息

Heer M, Altorfer J, Burger H R, Wälti M

出版信息

Gastroenterology. 1985 Jun;88(6):1954-7. doi: 10.1016/0016-5085(85)90025-3.

Abstract

A 78-yr-old man experienced a generalized bullous eruption of the skin (a Stevens-Johnson variant of erythema multiforme) with simultaneous involvement of the esophagus due to co-trimoxazole. Immunologic tests revealed specific antibodies of the immunoglobulin G class but not of the immunoglobulin E class against sulfamethoxazole, and in particular against trimethoprim. Lymphocyte transformation tests demonstrated sensitized lymphocytes against trimethoprim but not sulfamethoxazole. The esophageal mucosa showed intraepithelial vesicle formation with diffuse cytoplasmic deposits of immunoglobulin G. This adverse drug reaction involving both the skin and the esophagus appears to be immune-mediated.

摘要

一名78岁男性因复方新诺明出现全身性皮肤大疱性皮疹（多形红斑的史蒂文斯-约翰逊变异型），同时食管也受累。免疫测试显示存在针对磺胺甲恶唑，尤其是针对甲氧苄啶的免疫球蛋白G类特异性抗体，但不存在免疫球蛋白E类抗体。淋巴细胞转化试验表明存在针对甲氧苄啶而非磺胺甲恶唑的致敏淋巴细胞。食管黏膜显示上皮内水疱形成，伴有免疫球蛋白G的弥漫性细胞质沉积。这种累及皮肤和食管的药物不良反应似乎是免疫介导的。