背景:急性全身性发疹性脓疱病(AGEP)是一种严重的皮肤不良反应,其特征是迅速出现密集分布,小,无菌脓疱伴红斑。然而,其发病机制尚不完全清楚。羟氯喹广泛用于治疗自身免疫性疾病。一些患有AGEP的患者具有IL36RN和CARD14基因突变。我们的报告描述了与羟氯喹和新发现的CARD14基因突变相关的类风湿性关节炎和AGEP患者。
方法:一名28岁女性患有类风湿性关节炎,来氟米特治疗没有明显缓解关节痛,改用羟氯喹治疗后5天,出现多处皮疹,覆盖身体。
方法:根据患者的病史,症状,和组织病理学发现,诊断为AGEP。
方法:全外显子组测序和Sanger验证显示IL36RN基因没有突变;然而,存在CARD14基因突变。患者使用富马酸酮替芬片剂治疗,地塞米松磷酸钠,葡萄糖酸钙注射液,甲基强的松龙注射液,维生素C和B12,丁酸氢化可的松乳膏,芦苇祛痘霜,氯化钾片剂,和泮托拉唑肠溶胶囊。
结果:15天后皮疹好转。
■关于AGEP相关遗传学的基础研究很少,CARD14突变可能是几个脓疱性皮疹的基础,包括AGEP和泛发性脓疱型银屑病。需要进行后续研究并进一步积累患者数据。
BACKGROUND: Acute generalized exanthematous pustulosis (AGEP) is a serious adverse skin reaction characterized by the rapid appearance of densely distributed, small, sterile pustules with erythema. However, its pathogenesis is not fully understood. Hydroxychloroquine is widely used for the treatment of autoimmune diseases. Some patients presenting with AGEP have IL36RN and CARD14 gene mutations. Our report describes a patient with rheumatoid arthritis and AGEP associated with hydroxychloroquine and a newly discovered CARD14 gene mutation.
METHODS: A 28-year-old woman with rheumatoid arthritis, treated with leflunomide therapy without marked relief of joint pain, developed multiple rashes with pruritis covering the body 5 days after switching to hydroxychloroquine treatment.
METHODS: Based on the patient\'s history, symptoms, and histopathological findings, AGEP was diagnosed.
METHODS: Whole-exome sequencing and Sanger validation revealed no mutations in the IL36RN gene; however, a CARD14 gene mutation was present. The patient was treated using ketotifen fumarate tablets, dexamethasone sodium phosphate, calcium gluconate injection, methylprednisolone injection, vitamins C and B12, hydrocortisone butyrate cream, Reed acne cream, potassium chloride tablets, and pantoprazole enteric-coated capsules.
RESULTS: The rash improved after 15 days.
UNASSIGNED: There has been little basic research on AGEP-related genetics, and the CARD14 mutation may underlie several pustular rashes, including AGEP and generalized pustular psoriasis. Follow-up studies and further accumulation of patient data are required.