多形性红斑(EM)是一种延迟性红斑,临床表现不同的细胞介导的皮肤病。它通常与感染有关,但也可能与药物有关。疫苗,和自身免疫性疾病。非甾体抗炎药(NSAIDs)是常用的镇痛药,与EM和全血细胞减少症很少有关联。这些对NSAIDs的不良反应由于其稀有性而可能掩盖明确的诊断。我们介绍了一个案例,其中一名老年女性患者每天服用600毫克布洛芬,最多可服用四次肩囊炎,出现EM和全血细胞减少症。在这种情况下,一位有房颤病史的75岁女性,原发性高血压,非胰岛素依赖型2型糖尿病,和伴有残余右侧视力障碍的缺血性卒中,于2023年在我们的急诊科就诊,颈部肿胀,皮疹,和口腔溃疡。她报告了一个广义的,她开始定期服用布洛芬治疗左肩滑囊炎后15天出现的类靶体皮疹。以前没有开始其他药物治疗,之后,或在这段时间内。入院时的CBC非常显著,白细胞计数为1.5x109/L,血红蛋白6.5g/dL,血小板计数<10x109/L,与全血细胞减少症一致。布洛芬被停用了,患者接受了镇痛和充血红细胞输血的支持治疗。艾滋病毒检测,抗核抗体(ANA)面板,肝炎小组,铜和锌水平为阴性。皮肤上的类目标病变的活检显示出与EM一致的变化。食管胃十二指肠镜检查显示胃粘膜无活动性出血病变或溃疡。患者的血细胞计数最终通过支持治疗恢复,症状改善.患者入院后6天出院。医疗保健专业人员应该意识到NSAIDs罕见的血液学和免疫学副作用,这可能经常被忽视和误诊。需要更多的研究来建立我们关于EM的病因和管理的丰富知识,史蒂文·约翰逊综合征(SJS),和中毒性表皮坏死松解症(TEN)。
Erythema multiforme (EM) is a delayed, cell-mediated cutaneous disease with varying clinical manifestations. It is most commonly associated with infections but can also be associated with medications, vaccines, and autoimmune diseases. Non-steroidal anti-inflammatory Drugs (NSAIDs) are commonly used analgesics that have rare associations with EM and pancytopenia. These adverse reactions to NSAIDs can obscure definitive diagnosis due to their rarity. We present a case where an elderly female patient taking 600mg of ibuprofen up to four times a day for shoulder bursitis developed EM and pancytopenia. In this case, a 75-year-old female with a medical history of atrial fibrillation, essential hypertension, non-insulin-dependent type 2 diabetes mellitus, and ischemic stroke with residual right-sided visual impairment presented to our Emergency Department in 2023 with neck swelling, skin rash, and ulceration of the oral cavity. She reported a generalized, targetoid body rash that occurred 15 days after she started taking ibuprofen regularly for left shoulder bursitis. No other medications were started before, after, or during this time period. CBC on admission was remarkable for a white blood cell count of 1.5x109/L, hemoglobin of 6.5 g/dL, and platelet count <10x109/L, consistent with pancytopenia. Ibuprofen was discontinued, and the patient was treated supportively with analgesia and packed red blood cell transfusions. Testing for HIV, antinuclear antibodies (ANA) panel, Hepatitis panel, and copper and zinc levels were negative. A biopsy of a targetoid lesion on the skin showed changes consistent with EM. Esophagogastroduodenoscopy revealed no actively bleeding lesions or ulcers in the stomach mucosa. The patient\'s blood counts eventually recovered with supportive treatment, and symptomatology improved. The patient was discharged six days after admission. Healthcare professionals should be aware of rare hematologic and immunologic side effects of NSAIDs, which may often be overlooked and misdiagnosed. More studies are needed to build on our wealth of knowledge regarding the etiology and management of EM, Steven Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN).