摘要
1例77岁男性因左下肢带状疱疹疼痛口服氨酚待因片(Ⅰ)1片/d,连续20 d,布洛芬缓释胶囊0.3 g,仅1次,之后躯干、四肢出现暗紫红斑、水疱,伴疼痛,3 d后红斑面积变大,水疱增多,部分融合成大疱,尼氏征阳性,触痛阳性;口腔黏膜弥漫性潮红,无糜烂,皮损逐渐加重波及全身,诊断为大疱性表皮坏死松解型药疹而住院治疗。住院后第2天口唇、口腔黏膜糜烂,停用可疑药物氨酚待因片(Ⅰ)、布洛芬,给予注射用甲泼尼龙琥珀酸钠60 mg·d^(-1),ivd,枸地氯雷他定片8.8 mg·d^(-1),po,盐酸西替利嗪片10 mg·d^(-1),po,进行抗炎、抗过敏;丙酸氟替卡松乳膏和复方黄柏液适量外用预防感染,碳酸钙预防骨质疏松,奥美拉唑肠溶胶囊抑酸护胃等治疗。第6天患者口唇结痂大部分脱落,口腔黏膜糜烂面基本愈合,躯干及四肢水疱均干燥、结痂,无新起皮疹,药疹明显好转,第7天临床痊愈出院。考虑本次出现大疱性表皮坏死松解型药疹与氨酚待因片(Ⅰ)和布洛芬缓释胶囊使用后引起的药物变态反应有关。
A 77-year-old male patient with herpes zoster pain in left lower limb developed toxic epidermal necrolysis after treated with paracetamol and codeine tablets(I),1 tablet per day,for 20 days and ibuprofen sustained-release capsules 0.3 g.After medication,dark purple erythema and blisters appeared on the trunk and limbs,accompanied by pain.After 3 days,the area of erythema became larger,the number of blisters increased,and part of them fused into bullae.Nielsencs sign was positive,and tenderness was positive;the oral mucosa was diffusely flushed without erosion,the skin lesions gradually aggravated and spread all over the body.He was diagnosed with bullous epidermal necrolysis type drug eruption and hospitalized.He had lip and oral mucosa erosion on the second day after hospitalization.After discontinuing the suspected drugs of paracetamol and codeine tablets(I)and ibuprofen,the patient was given antihistamine and anti-allergic treatment:methylprednisolone sodium succinate for injection 60 mg·d^(-1)intravenously,desloratadine tablets 8.8 mg·d^(-1)orally,cetirizine hydrochloride tablets 10 mg·d^(-1)orally,fluticasone propionate cream appropriate for external use,compound phellodendron amurense solution appropriate for external use to prevent infection,calcium carbonate to prevent osteoporosis,omeprazole enteric-coated capsules to inhibit acid and protect stomach,and other treatments.On the 6th day,most of the patientsc lip scabs fell off,the erosion surface of oral mucosa was basically healed,the blisters on the trunk and limbs were dry and scabbed,and there was no new rash.The drug eruption was significantly improved.On the 7th day,the patients recovered and discharged from the hospital.It is considered that the occurrence of bullous epidermal necrolysis drug eruption is related to the drug allergy caused by the use of paracetamol and codeine tablets(I)and ibuprofen.
作者
李艳菊
范洁美
王芳
雷帅
段昕所
李响
Yan-Ju LI;Jie-Mei FAN;Fang WANG;Shuai LEI;Xin-Suo DUAN;Xiang LI(Chengde ADR Monitoring Center,Chengde 067000,Hebei Province,China;Drug Alert Center of Hebei Province,Shijiazhuang 050000,China;Department of Pharmacy,Affiliated Hospital of Chengde Medical University,Chengde 067000,Hebei Province,China;Department of Dermatology and Venereal Diseases,Affiliated Hospital of Chengde Medical University,Chengde 067000,Hebei Province,China)
出处
《药物流行病学杂志》
CAS
2023年第5期590-595,共6页
Chinese Journal of Pharmacoepidemiology
基金
河北省省级科技计划项目(21377714D)
关键词
氨酚待因片(Ⅰ)
布洛芬缓释胶囊
大疱性表皮坏死松解型药疹
药品不良反应
Paracetamol and codeine tablets(I)
Ibuprofen sustained-release capsules
Bullous epidermal necrolysis type drug eruption
Adverse drug reactions
