- 期刊
Bullous Pemphigoid with Esophageal Involvement Presenting as Exfoliative Esophagitis and Acute Upper Gastrointestinal Bleeding: Reports of Two Cases and Review of the Literature
類天疱瘡合併以剝落性食道炎及急性上消化道出血為表現之食道侵犯：兩個病例報告及文獻回顧
摘要
類天疱瘡是最常見好發於老年人的自體免疫水泡皮膚病。皮膚典型病灶呈現大而緊繃的水泡，水泡底部呈膚色、紅色或蕁麻疹樣，好發於下腹部、大腿內側及肢端曲側。百分之十到三十五的病患會有黏膜的病灶，多半都侷限於口腔黏膜。食道侵犯在臨床上相當罕見，表現可全無症狀，或併發吞厭困難及可能有危及生命的大量上消化道出血。我們在此報告兩位老年病患罹患新發之廣泛性類天疱瘡，經病理切片和免疫螢光染色確定診斷。其一病患發生嚴重吞厭困難，而內視鏡發現廣泛性剝落性食道炎及上消化道出血；另一病患發生灌食不佳及鼻胃管反抽發現消化道出血，內視鏡顯示數個位於中段及下段食道的潰瘍。兩位病患在全身性類固醇治療下迅速改善。
關鍵字
無資料並列摘要
Bullous pemphigoid is the most common autoimmune blistering skin disease usually occurs in the elderly. The characteristic skin lesions present large and tense blisters arising on normal, erythematous, or urticarial bases and most commonly involve lower abdomen, inner thighs and flexural areas. The mucous membrane lesions occur in about 10 to 35 percent of patients and are almost limited to the oral mucous membrane. Esophageal involvement is a rare condition which may be completely asymptomatic or complicates with dysphagia and even life-threatening massive upper gastrointestinal bleeding. We present two cases of elderly patients with newly onset extensive bullous pemphigoid confirmed by pathological and immunofluorescence studies. One patient developed severe dysphagia. Endoscopy revealed diffuse exfoliative esophagitis and upper gastrointestinal hemorrhage; the other patient developed poor feeding and hematemesis aspirated from nasogastric tube and endoscopy showed multiple ulcers occurred on mid and lower esophagus. Both patients showed much improvement after systemic corticosteroid use.