Popp J W, Harrist T J, Dienstag J L, Bhan A K, Wands J R, LaMont J T, Mihm M C
Arch Intern Med. 1981 Apr;141(5):623-9.
We encountered 11 patients who had rashes associated with hepatitis. Five of six acute hepatitis cases, but only one of five chronic hepatitis cases, were related to hepatitis B. Nine of the 11 patients had rash in the absence of clinically overt liver disease. Skin biopsy specimens showed histologic evidence of cutaneous vascular injury; specimens of urticarial and maculopapular rashes, which were seen in this series only with acute hepatitis, showed a primarily lymphocytic venulitis with focal necrosis, while palpable purpura, which was seen in this series only in chronic hepatitis, showed a primarily neutrophilic necrotizing vasculitis involving small vessels. One patient had lichen planus-like lesions. Demonstration of vascular deposits of immunoglobulins, complement, and fibrin in skin, as well as hypocomplementemia, circulating immune complexes, and mixed cryoglobulinemia, in these patients suggests that cutaneous lesions associated with liver disease resulted from immune complex-mediated vascular injury.
我们遇到了11例伴有皮疹的肝炎患者。6例急性肝炎病例中有5例，但5例慢性肝炎病例中只有1例与乙型肝炎有关。11例患者中有9例在无明显临床肝病的情况下出现皮疹。皮肤活检标本显示有皮肤血管损伤的组织学证据；本系列中仅在急性肝炎患者中出现的荨麻疹和斑丘疹皮疹标本显示主要为淋巴细胞性小静脉炎伴局灶性坏死，而本系列中仅在慢性肝炎患者中出现的可触及紫癜显示主要为累及小血管的嗜中性坏死性血管炎。1例患者有扁平苔藓样病变。这些患者皮肤中免疫球蛋白、补体和纤维蛋白的血管沉积，以及低补体血症、循环免疫复合物和混合性冷球蛋白血症的表现提示，与肝病相关的皮肤病变是由免疫复合物介导的血管损伤所致。
