類天皰瘡與疑似克隆氏症併發腸膀胱瘻管之免疫性共病病案討論

A Discussion of immune comorbidities of pemphigoid and suspected Crohn's disease complicated with enterovesical fistula

黃嘉貞(Chia-Cheng Huang) ； 盧恩佑(En-You Lu) ； 蔡文興(Wen-Hsin Tsai)

《中醫內科醫學雜誌》 21卷1期 (2023/06) Pp. 36-48

https://doi.org/10.7102/JTCIM.202306_21(1).0004

摘要

類天皰瘡是自體免疫疾病，抗體攻擊表皮與真皮間構造，四肢至全身產生癢痛水泡，破皮結痂又長出新水泡。克隆氏症病與自體免疫、感染、腸道內菌落改變、遺傳等因素相關，常見症狀為血便、腹瀉、腹痛及反覆腹內感染。本病例為89歲女性，腦梗塞長期行動不便且無法自行飲食，久病致免疫力低下，出現類天皰瘡、褥瘡、血便與糞尿症。中醫辨證分析證型屬濕熱蘊脾胃、氣血虧虛及心脾兩虛，治則為袪濕清熱解毒、健脾益胃、益氣養血、補益心脾；藥方以益氣補血、托裏排膿解毒的托裏消毒飲為主，加減清血熱袪濕方藥。治療後，四肢及軀幹類天皰瘡除病兆處結痂脫落膚色有色差外，幾乎痊癒；臀部褥瘡侵蝕深度改善；血便已無，惟後續發現有糞尿症持續治療中。

關鍵字

類天皰瘡 ； 克隆氏症 ； 糞尿症 ； 自體免疫 ； 托裏消毒法

並列摘要

Pemphigoid is an autoimmune disease. Abnormal antibodies in the body attack the structure between the epidermis and the dermis, resulting in itchy blisters. The most common locations are the limbs and even the whole body. The etiology of Crohn's disease is mostly related to factors such as autoimmunity, infection, changes in intestinal flora, and genetics. Common symptoms include bloody stools, diarrhea, abdominal pain, and repeated intra-abdominal infections. This case discusses an 89-year-old woman who suffered from cerebral infarction for a long time, inconvenience of movement and inability to eat and drink on her own, resulting in low immunity and concurrent pemphigoid, bedsores, bloody stools and fecaluria. According to Traditional Chinese Medicine (TCM) syndrome differentiation analysis, the syndrome types belong to damp-heat accumulation in the spleen and stomach, deficiency of both Qi and blood, and deficiency of both the heart and spleen. The TCM principle of treatment included removing dampness and clearing heat-toxin, invigorating spleen for benefiting stomach, benefiting qi and nourishing blood, invigorating heart and spleen. The prescription, Tuo Li Xiao Du Yin, is mainly used for detoxification and benefiting qi and nourishing blood with the prescription of clearing heat from blood and removing dampness. After treatment, the pemphigoid on the limbs and trunk almost recovered except for the scabs and skin color difference at the symptoms of the disease; the erosion depth of the buttocks ulcers improved; there was no blood in the stool, but the phenomenon of fecaluria was found later, and the treatment was continued.

並列關鍵字

pemphigoid ； Crohn's disease ； fecaluria ； autoimmunity ； Tuo-Li-Xiao-Du method

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