CAJ | 학술논문

报道维A酸治疗银屑病致维A酸综合征1例.患者男.32岁.有寻常性银屑病病史10余年.患者10余年来,头皮、躯干、四肢反复发红色斑丘疹、斑块,表面覆有多层银白色鳞屑,伴瘙痒,确诊为银屑病,长期口服维生素类、中成药及外用药物治疗,皮损缓解与加重交替.半年前因皮疹加重,给予阿维A(方希)胶囊10 mg每13 2次共20 d,后增至10 mg每日3次共30 d,皮疹好转后,减至10 mg每13 2次巩固治疗,连续用药半年,皮疹基本消退.就诊前1周改为口服维胺酯(三蕊)胶囊50 mg每13 2次,3 d后皮疹加重,炎症反应明显,随后皮疹迅速泛发全身,融合成大片状,水肿明显,大量脱屑,伴高热,体温达39℃以上,并伴低血压、呼吸困难、肺水肿、胸腔和心包积液、肾功能异常及血白细胞明显升高.诊断为维A酸综合征.经糖皮质激素及对症支持治疗,症状均改善.维A酸综合征发生急骤,病情凶险,需及时诊断、并积极采用糖皮质激素及对症支持治疗.
보도유A산치료은설병치유A산종합정1례.환자남.32세.유심상성은설병병사10여년.환자10여년래,두피、구간、사지반복발홍색반구진、반괴,표면복유다층은백색린설,반소양,학진위은설병,장기구복유생소류、중성약급외용약물치료,피손완해여가중교체.반년전인피진가중,급여아유A(방희)효낭10 mg매13 2차공20 d,후증지10 mg매일3차공30 d,피진호전후,감지10 mg매13 2차공고치료,련속용약반년,피진기본소퇴.취진전1주개위구복유알지(삼예)효낭50 mg매13 2차,3 d후피진가중,염증반응명현,수후피진신속범발전신,융합성대편상,수종명현,대량탈설,반고열,체온체39℃이상,병반저혈압、호흡곤난、폐수종、흉강화심포적액、신공능이상급혈백세포명현승고.진단위유A산종합정.경당피질격소급대증지지치료,증상균개선.유A산종합정발생급취,병정흉험,수급시진단、병적겁채용당피질격소급대증지지치료.
To report a case of retinoic acid syndrome due to tretinoin in the treatment of psoriasis.A 32-year-old male patient presented with psoriasis vulgaris for more than 10 years.In recent 10 years,he experienced erythema,plaques covered with multi-layered scales on the scalp,trunk,extremities accompanied by pruritus.The patient was diagnosed as psoriasis and given long-term treatment with oral vitamins,traditional Chinese medicine,and topical drugs,which resulted in a status of remission and exacerbation.Half a year prior to the presentation,the patient was given acitretin 10 mg twice daily due to the exacerbation of condition;20 days later,the dose increased to thrice daily;after another 30 days,the lesions were improved,and the frequency decreased to twice daily again;finally,a disappearance of the lesions was achieved after half a year of maintenance treatment with acitretin 10 mg twice daily.One week prior to the presentation,the treatment strategy was altered from acitretin to viaminate 50 mg twice daily;after three days with viaminate,the patient experienced a sudden worsening of psoriatic lesions with an obvious inflammatory reaction;subsequently,the lesions rapidly spread to the whole body surface and fused into large patches,accompanied with the following signs:marked edema,massive desquamating,high fever (＞39℃),hypotension,respiratory distress,pulmonary edema,pleural and pericardial effusions,renal dysfunction,peripheral blood leukocytosis.The patient was diagnosed as retinoic acid syndrome(RAS).After given oral glucocorticoid,symptomatic and supportive treatment,he experienced a relief of symptoms.These findings indicate that RAS is an entity with an abrupt onset and poor prognosis.For patients with RAS,early diagnosis and prompt management with corticosteroids,symptomatic and supportive treatments are essential to avoid potential fatal complications.