Huang Yiqi, Fu Tianxiao, Zhang Yanling, Shen Weigang, Sang Weiwei, Han Meixiang, Wang Fang, Chen Fenjuan
Department of Nephrology, Shaoxing Second Hospital, Shaoxing, Zhejiang, China.
Department of Traditional Chinese Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China.
Front Med (Lausanne). 2024 Oct 3;11:1421109. doi: 10.3389/fmed.2024.1421109. eCollection 2024.
Icodextrin is a type of peritoneal dialysis (PD) osmolyte that can be extended retention times (8-16 h) and may offer a viable alternative to conventional glucose dialysis solutions for PD patients. Nonetheless, prolonged use of icodextrin may lead to allergic rash, and rarely severe skin lesions.
In February 2024, a 45-year-old male was admitted to the Department of Nephrology at Shaoxing Second Hospital presenting with a 3-day history of intense generalized pruritic erythematous rash. Physical examination revealed diffuse erythematous pruritic rash and exfoliative rash, particularly on the abdominal. Abnormal laboratory findings included elevated eosinophil count and total IgE levels, indicative of an allergic rash. Standard anti-allergic regim was initiated. However, on the third day in the hospital, the patient developed new pustules on his neck and arms. Subsequent historical investigation uncovered that the individual had previously administered icodextrin 2 weeks prior due to volume overload, and the last intraperitoneal administration time was second day of hospitalization. The dermatologist rendered a diagnosis of generalized exfoliative rash and acute localized exanthematous pustulosis (ALEP) induced by icodextrin, and initiated prophylactic antimicrobial therapy accordingly. Furthermore, the patient declined to undergo a skin biopsy. Noteworthy is the observation that the rash ameliorated and the pustules resolved by the seventh day post-admission. Presently, the patient is still under clinical follow-up.
This article aims to report the first case of severe allergic rash caused by icodextrin in Chinese PD patients and highlight the potential for icodextrin to trigger ALEP. A literature review of similar cases found that severe allergic rash induced by icodextrin is rare, the underlying mechanism remains poorly understood, and the prognosis is positive with proper treatment.
艾考糊精是一种腹膜透析（PD）渗透剂，可延长保留时间（8 - 16小时），对于PD患者而言，它可能是传统葡萄糖透析液的一个可行替代方案。尽管如此，长期使用艾考糊精可能会导致过敏性皮疹，严重的皮肤损伤则较为罕见。
2024年2月，一名45岁男性因全身剧烈瘙痒性红斑皮疹3天入住绍兴第二医院肾病科。体格检查发现弥漫性红斑瘙痒皮疹和剥脱性皮疹，尤其是腹部。实验室检查异常包括嗜酸性粒细胞计数和总IgE水平升高，提示过敏性皮疹。开始采用标准抗过敏治疗方案。然而，住院第三天，患者颈部和手臂出现新的脓疱。随后的病史调查发现，该患者因容量超负荷在两周前曾使用过艾考糊精，最后一次腹腔给药时间为住院第二天。皮肤科医生诊断为艾考糊精引起的全身性剥脱性皮疹和急性局限性脓疱性发疹（ALEP），并相应地开始预防性抗菌治疗。此外，患者拒绝接受皮肤活检。值得注意的是，皮疹在入院后第七天有所改善，脓疱消退。目前，该患者仍在临床随访中。
本文旨在报告中国PD患者中首例由艾考糊精引起的严重过敏性皮疹病例，并强调艾考糊精引发ALEP的可能性。对类似病例的文献综述发现，由艾考糊精引起的严重过敏性皮疹很少见，其潜在机制仍知之甚少，但经过适当治疗预后良好。
