放射性皮炎继发大疱性类天疱疮一例

【摘要】 目的 报告放射性皮炎继发大疱性类天疱疮1例，探讨大疱性类天疱疮与放射性皮炎的相关发病机制。病例内容 患者女，82岁，左乳腺癌切除术后10年，术后放疗处出现放射性皮炎。半月前于放射性皮炎位置开始出现浮肿性红斑，水疱，大疱，尼氏征阴性，并伴有瘙痒，随后于背部，下肢出现二处水疱。组织病理为表皮下疱，免疫病理显示基底膜带IgG和C3沉积，血清中存在针对基底膜带成分的自身抗体。予米诺环素加烟酰胺治疗两周后病情控制满意。结论 放射性皮炎继发大疱性类天疱疮国际上偶见报道，有学者认为局部放疗能改变基底膜的性质，使自身抗原暴露，引起自身免疫反应；并能影响金属基质蛋白酶和血管内皮生长因子的表达，故认为大疱性类天疱疮有可能是放疗的一个潜在副作用。

A case of radio-dermatitis secondary to bullous pemphigoid

Absrtact] Objective To report a case of radiation-induced bullous pemphigoid, explore the correlation of radiodermatitis and bullous pemphigoid. Patient and Intervention An 82-year-old female patient presented with blisters mainly on left chest wall for half a month. She had a history of postoperative radiation therapy after a left breast carcinoma resection, and recurrent radiation dermatitis on her left chest wall. The blisters are well beyond the radiation field. A biopsy and immunofluorescence of the lesions confirmed the diagnosis of bullous pemphigoid. After two weeks use of minocin and nicotinamide, complete remission was got. Conclusions Radiation-induced bullous pemphigoid was seldom reported. Radiation may alter the property of basal membrane, unmask the autoantigen, induce autoimmune response, and influence MMP-9 (matrix metalloproteinase 9) and VEGF (vascular endothelial growth factor) expression. Bullous pemphigoid may be considered to be a side effect of irradiation.