A 72-year-old man presented to the emergency department with a 2-day history of an itchy rash on his back. On physical examination, edematous, flagellate plaques and linear patches were present across the patient’s entire back and upper buttocks. There was no adenopathy, dermographism, or mucosal involvement. What substance had the patient most likely handled and ingested before subsequently developing this rash?
一名72岁男性因背部皮疹发痒2日到急诊科就诊。体格检查时，患者整个背部和臀部上部均有水肿、鞭毛状斑块和线状斑。无腺病、皮肤划痕征或黏膜受累。在随后出现皮疹之前，患者最有可能使用和摄入了什么物质?
A. Phenytoin 苯妥英
B. Shellfish 贝类
C. Shiitake mushrooms 香菇
D. Toxicodendron radicans (poison ivy) 毒藤
E. Warfarin 华法林
答案解析：
正确答案是香菇。在症状出现前2日，患者分享了他准备并吃了一顿含有香菇的饭。食用生的或未煮熟的香菇后会发生香菇皮炎。特征性条纹状皮疹(也称为鞭毛性红斑)也可见于暴露于博来霉素后，或者在罕见情况下见于皮肌炎或成人斯蒂尔病。这种情况是自限性的。给予外用糖皮质激素和口服抗组胺药治疗。2周随访时，炎症后色素沉着残留，但瘙痒减轻。
正确答案：C
特别申明：本文为转载文章，转载自NEJM，不代表贪吃的夜猫子立场，如若转载，请注明出处：https://www.nejm.org/image-challenge
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