옻에 의한 급성 전신성 발진성 농포증이 Anti-TNFα로 호전된 2예
Anti-TNFα Treatment for Two Cases of Acute Generalized Exanthematous Pustulosis Caused by Rhus Hypersensitivity
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초록
AGEP는 원인물질에 대한 노출을 중단하면 평균 15일 이내로 호전될 수 있는 비교적 양호한 경과를 보이는 것으로 알려져 있으나 문헌에 따라 약 5%의 사망률이 보고된 바 있는 중증피부과민 반응에 해당된다. 저자들은 옻 섭취 또는 접촉 후에 발생한 발열, 백혈구 증가, 점막침범을 동반한 AGEP 환자에서 스테로이드제 투여 중 농포가 진행하고, 발열 및 간효소치 상승소견을 보여 항TNF-α제 1-2회 투여 후 급속한 경과 호전을 보인 2예를 경험하였다. 원인회피 및 보존적 치료에도 임상적 호전이 느리고, 장기간 입원을 요하는 AGEP의 경우 항TNF-α 치료를 고려해 볼 수 있을 것이다.
Abstract
Acute generalized exanthematous pustulosis (AGEP) is characterized by the rapid occurrence of many sterile, nonfollicular pustules on an edematous erythema accompanied by leucocytosis and fever. It is usually attributed to drugs, including herbal medications such as rhus in Korea. We report two cases of AGEP due to rhus hypersensitivity treated with anti-tumor necrosis factor (TNF)-α. The patients developed a generalized erythematous rash and edema, particularly on the face, with high fever and leukocytosis several days after ingesting rhus chicken or contacting rhus extract. Following treatment with a systemic steroid, the skin rash spread to the entire body and pustules arose on an edematous erythema. After stopping the systemic steroid and administering a subcutaneous injection of Etanercept, the pustular rashes, fever, and edema improved within 4 days. These results suggest that anti-TNF-α treatment may be effective for rapidly improving AGEP. (Korean J Med 2011;81:537-542)
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