药物致黄斑丘疹vs.病毒性黄斑丘疹:解决困境

IF 1.6 Q3 DERMATOLOGY
S. Khandpur, R. Ahuja
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引用次数: 2

摘要

黄斑丘疹是一种常见的临床表现,其两种最常见的病因,即病毒和药物引起的区分,往往造成诊断困境。临床、血液学和生化检查在区分药物反应和病毒检查方面很少可靠。某些关键的组织病理学特征,如存在中度海绵状病,广泛的基底细胞损伤伴多个坏死角质形成细胞和真皮浸润丰富的嗜酸性细胞或淋巴细胞和组织细胞,可能有利于药物检查,而明显的表皮细胞病变和淋巴细胞血管炎则指向病毒病因。同样,显著的免疫组织化学标志物如IL-5、eotaxin和FAS配体可能支持药物性黄斑丘疹的诊断。当面临临床重叠时,组织病理学和免疫组织化学评估可能有助于区分两种病因,特别是在需要多种基本药物且无法停药和重新挑战的患者中。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Drug-Induced vs. Viral Maculopapular Exanthem—Resolving the Dilemma
Maculopapular exanthem is a commonly encountered presentation in routine clinical practice, and differentiation between its two most common etiologies, i.e., viral- and drug-induced, often poses a diagnostic dilemma. Clinical, hematological and biochemical investigations are seldom reliable in distinguishing between a drug reaction and a viral exanthem. Certain key histopathological features such as the presence of a moderate degree of spongiosis, extensive basal cell damage with multiple necrotic keratinocytes and dermal infiltrate rich in eosinophils or lymphocytes and histiocytes may favor a drug exanthem, while distinctive epidermal cytopathic changes and lymphocytic vasculitis point towards a viral etiology. Similarly, notable immunohistochemical markers such as IL-5, eotaxin and FAS ligand may support a diagnosis of a drug-induced maculopapular eruption. Histopathological and immunohistochemical evaluations may help in distinguishing between the two etiologies when faced with a clinical overlap, especially in patients on multiple essential drugs when drug withdrawal and rechallenge is not feasible.
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来源期刊
Dermatopathology
Dermatopathology DERMATOLOGY-
自引率
5.30%
发文量
39
审稿时长
11 weeks
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