Simonart T, Durez P, Margaux J, Van Geertruyden J, Goldschmidt D, Parent D
Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Clin Rheumatol. 1997 Nov;16(6):623-5. doi: 10.1007/BF02247805.
Large haemorrhagic and necrotic cutaneous lesions developed after two low dose (5 mg) methotrexate injections in a patient suffering from long standing rheumatoid arthritis. Differential clinical diagnosis included factitia dermatitis, infectious processes, pyoderma gangrenosum, rheumatoid neutrophilic dermatitis, necrotizing arteritis and vasculitis. Histological and direct immunofluorescent examinations of skin biopsies supported the diagnosis of leucocytoclastic vasculitis. We discuss the respective roles of methotrexate and rheumatoid arthritis in the outbreak of leucocytoclastic vasculitis. Hypersensitivity is strongly suspected.
一名患有长期类风湿性关节炎的患者在注射两次低剂量（5毫克）甲氨蝶呤后出现了大面积出血性和坏死性皮肤病变。鉴别临床诊断包括人工性皮炎、感染性病变、坏疽性脓皮病、类风湿性嗜中性皮病、坏死性动脉炎和血管炎。皮肤活检的组织学和直接免疫荧光检查支持白细胞碎裂性血管炎的诊断。我们讨论了甲氨蝶呤和类风湿性关节炎在白细胞碎裂性血管炎发作中的各自作用。强烈怀疑存在超敏反应。
