低剂量甲氨蝶呤诱发的白细胞破碎性血管炎：免疫机制的体外证据

Leukocytoclastic vasculitis induced by low-dose methotrexate: in vitro evidence for an immunologic mechanism.

作者信息

Halevy S, Giryes H, Avinoach I, Livni E, Sukenik S

机构信息

Department of Dermatology, Soroka, Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

出版信息

J Eur Acad Dermatol Venereol. 1998 Jan;10(1):81-5.

PMID:9552765

Abstract

The rare occurrence of methotrexate (MTX)-induced vasculitis has been associated mainly with high or intermediate MTX doses. We report herein a case of cutaneous leukocytoclastic vasculitis (LCV) following treatment with low-dose oral MTX (7.5 mg/week) for rheumatoid arthritis. The histological findings of a cutaneous lesion were consistent with drug-induced vasculitis. The clinical and histological findings, including the temporal relationship between MTX intake and the onset of vasculitis, and the results of withdrawal and rechallenge tests, suggest a causal relationship, and indicate a drug-induced LCV due to MTX. The role of MTX in the induction of the vasculitis was further supported by a positive mast cell degranulation (MCD) test.

摘要

甲氨蝶呤（MTX）诱发的血管炎罕见，主要与高剂量或中等剂量的MTX有关。我们在此报告一例类风湿关节炎患者在接受低剂量口服MTX（7.5毫克/周）治疗后发生皮肤白细胞破碎性血管炎（LCV）的病例。皮肤病变的组织学检查结果与药物性血管炎一致。临床和组织学检查结果，包括MTX摄入与血管炎发作之间的时间关系，以及撤药和再激发试验的结果，提示存在因果关系，并表明是由MTX引起的药物性LCV。肥大细胞脱颗粒（MCD）试验呈阳性进一步支持了MTX在诱发血管炎中的作用。