Inadomi T, Saito T, Kaneko M, Hashimoto T, Suzuki H
Department of Dermatology, Nihon University, Tokyo, Japan.
J Dermatol. 1997 Mar;24(3):179-83. doi: 10.1111/j.1346-8138.1997.tb02768.x.
A case of bullous pemphigoid (BP) in a 47-year-old female hepatitis B virus (HBV) carrier is reported. Disseminated bullae covered the patient's entire body including the hands and feet. BP was diagnosed on the basis of pathological and immunological observations examining immunofluorescence and cross reactions to both bullous pemphigoid antigen (BPAG) 1 and BPAG 2. Although oral prednisolone (80 mg daily) rapidly healed the eruption, liver function failed to respond, resulting in the patient's death. This liver dysfunction was attributed to the HBV infection. Use of the polymerase chain reaction showed that HBV in this case had transformed into its precore mutation form during the therapy. Standard tests on first examination did not detect HBV in this patient, but later detailed analysis suggested that she had been an HBV carrier since birth. Such carriers sometimes test negative for HBs antigen, when only a little HBV is present in the liver. Great care should also be exercised when using high doses of corticosteroids to treat bullous diseases in HBV carriers, because these drugs may aggravate HBV infections and cause liver failure.
报告了一例47岁女性乙型肝炎病毒（HBV）携带者患大疱性类天疱疮（BP）的病例。患者全身包括手足出现弥漫性水疱。根据病理和免疫学观察结果，通过免疫荧光以及对大疱性类天疱疮抗原（BPAG）1和BPAG 2的交叉反应诊断为BP。尽管口服泼尼松龙（每日80mg）迅速使皮疹愈合，但肝功能未恢复，导致患者死亡。这种肝功能障碍归因于HBV感染。聚合酶链反应检测显示，该病例中的HBV在治疗期间已转变为前核心突变形式。首次检查时的标准检测未在该患者中检测到HBV，但后来的详细分析表明她自出生以来就是HBV携带者。当肝脏中仅存在少量HBV时，此类携带者有时HBs抗原检测呈阴性。在使用高剂量皮质类固醇治疗HBV携带者的大疱性疾病时也应格外小心，因为这些药物可能会加重HBV感染并导致肝衰竭。
