每日一题_2024.02.08

An otherwise healthy 42-year-old woman presented with a 10-day history of a rash in her axillae and on her groin and abdomen. One and a half weeks before the onset of the rash, she had started taking dexketoprofen (a nonsteroidal antiinflammatory drug [NSAID]) at a dose of 25 mg per day to treat knee pain. She reported no fevers, mucosal lesions, or symptoms other than mild pruritus. On physical examination, symmetric patches of reddish-purple skin with peeling borders were present in the cervical and axillary regions (top-left), the abdominal and inguinal regions (right), and the intertriginous area of the back (bottom-left). What drug class is the most common trigger of this rash?

一名其他方面健康的42岁女性因腋窝、腹股沟和腹部皮疹10天就诊。皮疹发生前1周半，患者开始服用每日25 mg的右酮洛芬(一种非甾体抗炎药[NSAID])治疗膝关节疼痛。除轻度瘙痒外，患者自诉无发热、黏膜病变或其他症状。体格检查时，颈部和腋窝(左上)、腹部和腹股沟(右上)以及背部的间质区(左下)出现边缘脱皮的对称性红紫色斑片。哪种药物是引发这种皮疹的最常见原因?

A. Angiotensin receptor blockers 血管紧张素受体阻滞剂

B. Beta lactam antibiotics β -内酰胺类抗生素

C. Estrogens 雌激素

D. Fluoroquinolones 氟喹诺酮类原料药

E. Sulfonamides 磺胺类药

答案解析：

由于皮疹的出现和患者使用的非甾体抗炎药，我们做出了对称性药物相关的错综和弯曲性疹(SDRIFE)的诊断。SDRIFE是一种药疹，其特征是在刺突区和弯曲区出现对称性红斑，且无全身症状。最常见的诱因包括β -内酰胺类药物的使用，但也包括大环内酯类药物和nsaid。开始使用一个疗程的外用糖皮质激素治疗，并建议停用右酮洛芬治疗。

正确答案：B