背景:大疱性类天疱疮是最常见的慢性复发性自身免疫性表皮下起泡性疾病,在老年人群中最为普遍。从紧张的大疱到强烈的全身性瘙痒,其临床表现差异很大。它在IgG抗体存在的情况下是免疫起源的。
方法:一名47岁女性到医院就诊,主诉下肢有水泡,她用印尼的话油自我管理,之后水泡出现在身体上。患者还出现了上肢和下肢的水疱,臀区,痛苦的广义的uclers,坏死斑块,多个红斑水泡,双侧腿和上肢溃疡糜烂,几乎没有病变,有恶臭和渗出。入学的第二天,检测患者的CRP和ESR水平,水平分别为33.5和35mm/hr。患者每天三次注射美罗培南1克,每天一次注射地塞米松4mg,每天一次注射氧氟沙星400mg。入学的第三天,患者主诉腿部肿胀,随后对D-二聚体水平进行了检查,结果显示值为5,740,并在整个住院期间接受了40mg依诺肝素注射液治疗。皮肤活检证实诊断为大疱性类天疱疮..培养试验显示肺炎克雷伯菌和鲍曼不动杆菌的生长,对大多数抗生素都有抗药性。对患者进行了适当的治疗,包括抗生素,抗炎药,免疫抑制剂,多种维生素,流体,和白蛋白。患者对治疗反应良好,没有新的病变或发烧高峰。出院时仅存在旧病变的坏死斑块。
结论:本病例报告的目的是提出一例大疱性类天疱疮的典型病例,该病例因应用印em油而加重,并强调民间药物在自身免疫性疾病如大疱性类天疱疮中的不当使用。
BACKGROUND: Bullous pemphigoid is the most common chronic recurrent autoimmune subepidermal blistering disorder most prevalent in the geriatric population. It varies widely in clinical presentation ranging from tense bullae to intense generalized pruritus. It is immunologic in origin with the presence of IgG antibodies.
METHODS: A 47-year-old female presented to the hospital with complaints of blisters in the lower limbs, which she self managed with neem oil, after which the blisters occurred over the body. The patient also experienced blisters over both upper and lower limbs, gluteal region, painful generalized ulcers, necrotic patches, multiple erythematous blisters, ulcer erosions over bilateral legs and upper limbs with few lesions, which were foul-smelling and oozing. On the second day of admission, the patient\'s CRP and ESR levels were tested and the levels were 33.5 and 35 mm/hr, respectively. The patient was treated with an injection of meropenem 1 g three times daily, dexamethasone 4 mg once daily, and ofloxacin 400 mg once daily. On the third day of admission, the patient complained of leg swelling, and subsequently, D-Dimer levels were checked, which showed a value of 5,740 and was treated with an injection of enoxaparin 40 mg for the same throughout the course of the hospital stay A skin biopsy confirmed the diagnosis of bullous pemphigoid. The culture test showed the growth of Klebsiella pneumonia and Acinetobacter baumani, which were resistant to most of the antibiotics. The patient was managed appropriately with modalities including antibiotics, anti-inflammatory agents, immunosuppressants, multivitamins, fluids, and albumin. The patient responded well to the treatment without new lesions or fever spikes. There was the presence of necrotic patches of old lesions alone at the time of discharge.
CONCLUSIONS: This
case report was done with the purpose of presenting an exemplary
case of bullous pemphigoid aggravated by the application of neem oil and emphasizing the inappropriate use of folk medicine in an autoimmune disease like bullous pemphigoid.