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某科技有限公司一员工接触TCE 2周后,出现双上肢皮疹、发热,治疗后好转回原车间工作;3周后双手又出现散在红色斑丘疹,并迅速蔓延至四肢,伴躯干及头面部皮肤潮红。该患者所使用的清洁剂三氯乙烯的挥发性有机组分峰丰度为39.6%。入院时查体:双上肢、前胸、后背部皮疹色稍红,均已融合成片,双下肢见陈旧散在及融合成片的暗红色斑丘疹,部分脱屑。予糖皮质激素及护肝药等治疗,入院第3天耳后出现疖肿感染,10 d后患者疖肿治愈,110 d后全身未见新发皮疹,肝功能明显好转,停用激素,1周后反复出现发热、腹泻,大便涂片见真菌,随后出现颈部肿痛,双侧颈部甲状腺Ⅱ度肿大,双手轻微震颤,查甲状腺功能示T3、T4明显升高,TSH明显降低,考虑为graves病。提示TCE药疹样皮炎、感染及精神压力可能作为诱发因素,诱发体内的免疫功能紊乱,导致graves病的发生。
After a staff member of a technology limited company contacted TCE for 2 weeks, a double upper extremity rash appeared and became feverish. After treatment, the employee improved and returned to the original factory work. After 3 weeks, scattered red rash appeared in both hands and spread rapidly to the extremities with the trunk and facial skin Flushing. The patient used the trichlorethylene volatile organic component peak abundance of 39.6%. Admission examination: double upper extremity, chest, back of the skin rash reddish, have been integrated into a film, see the old lower limbs scattered and merged into pieces of dark red rash, some scaling. Glucocorticoid and hepatoprotective drugs were given. On the 3rd day after admission, the patient had a swollen infection. After 10 days, the swollen hematoma was cured. No new-onset rash occurred on the whole body after 110 days. The liver function was obviously improved and the hormone was stopped. 1 Week after repeated fever, diarrhea, stool smear see the fungus, followed by neck swelling and pain, both sides of the neck thyroid enlargement, his hands slightly tremor, check thyroid function showed significantly increased T3, T4, TSH significantly lower, Consider graves disease. Tip TCE drug-like dermatitis, infection and mental stress may be used as a predisposing factor to induce immune dysfunction in vivo, leading to the occurrence of graves disease.