大疱性类天疱疮合并结核感染4例及文献复习

左亚刚; 晋红中; 王宏伟; 乔菊; 刘跃华; 刘洁; 孙秋宁; 王家璧

doi:10.3969/j.issn.1674-9081.2012.04.003

大疱性类天疱疮合并结核感染4例及文献复习

Bullous Pemphigoid Complicated with Tuberculosis: Report of 4 Cases and Literature Review

摘要

摘要:
目的探讨大疱性类天疱疮(bullous pemphigoid, BP)合并结核杆菌感染的临床、实验室和诊治特点。
方法回顾性分析1990年1月至2012年4月北京协和医院皮肤科4例住院的有完整记录的BP合并结核杆菌感染患者的临床资料, 总结其诊治规律。
结果 4例患者中3例结核菌素(purified protein derivative, PPD)试验阴性, 1例阳性。4例患者的嗜酸性粒细胞水平明显升高, 且与病情相平行。3例患者采用皮质类固醇激素和利福平为主的三联抗痨药, 1例采用异烟肼、乙胺丁醇、吡嗪酰胺和皮质类固醇激素治疗; 2例皮质类固醇激素剂量超过180 mg/d。3例患者皮损全部消退, 结核感染得到控制。2例静脉点滴人免疫球蛋白有短期疗效。
结论对于长期应用皮质类固醇激素的BP患者仔细筛查潜在的结核感染至关重要。在皮质类固醇激素应用患者中, PPD试验可出现假阴性。为此, 若同时应用皮质类固醇激素与利福平, 皮质类固醇激素的剂量应增加一倍以上。此外, 人免疫球蛋白也是治疗BP合并结核感染的一种较好方法。

Abstract:
Objective To explore the clinical and laboratory characteristics of bullous pemphigoid (BP) complicated with tuberculosis.
Methods The clinical data of 4 inpatients with BP complicated with tuberculosis, who were diagnosed and treated in Department of Dermatology, PUMC, from January 1990 to April 2012, were retrospectively analyzed, and meanwhile the relevant literature was reviewed.
Results Purified protein derivative (PPD) test showed negative results in three patients and positive in the remaining one patient. The level of eosinophils in all these 4 cases remarkably increased and was parallel with the severity of the disease. Three patients received rifampicin and prednisone combination therapy and the remaining one patient was treated with isoniazide, ethambutal, pyrazinamide, and corticosteroid. The dose of prednisone exceeded 180 mg/d in 2 patients. Clinical complete remission of bulla was achieved in 3 patients, and tuberculosis was also controlled. Intravenous immunoglobulin showed short-term efficacy in 2 patients.
Conclusions The potential tuberculosis infection should be carefully screened in BP patients who have received long-term steroid treatment. PPD often shows false negative results in these patients. If rifampicin and prednisone are used in combination, the dose of prednisone should be increased by at least two fold. Furthermore, intravenous immunoglobulin provides a good alternative treatment for BP with tuberculosis.

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