Craycraft Margaret E, Arunakul Vechai L, Humeniuk John M
Department of Pharmacy Services, Greenville Hospital System, Greenville, South Carolina 29605, USA.
Pharmacotherapy. 2005 Feb;25(2):308-12. doi: 10.1592/phco.25.2.308.56953.
A 52-year-old man with no previous drug allergies or skin disorders developed a widespread papulovesicular rash while receiving an antimicrobial regimen of piperacillin-tazobactam, tobramycin, and vancomycin. Skin biopsy suggested leukocytoclastic vasculitis, which responded well to antibiotic discontinuation and steroid therapy. Fifteen days later, during steroid tapering, an additional course of vancomycin was begun for suspected line infection. The subsequent maculopapular rash that developed was diagnosed as toxic epidermal necrolysis (TEN) based on a second skin biopsy and clinical presentation. This case is consistent with previous reports of vancomycin-associated TEN. Any patient who develops TEN while receiving vancomycin therapy should be evaluated for possible vancomycin-induced TEN.
一名52岁男性，既往无药物过敏史及皮肤疾病，在接受哌拉西林 - 他唑巴坦、妥布霉素和万古霉素的抗菌治疗方案时，出现了广泛的丘疹水疱性皮疹。皮肤活检提示白细胞破碎性血管炎，停用抗生素及类固醇治疗后反应良好。15天后，在类固醇减量过程中，因怀疑导管感染开始了另一疗程的万古霉素治疗。随后出现的斑丘疹皮疹经第二次皮肤活检及临床表现诊断为中毒性表皮坏死松解症（TEN）。该病例与先前关于万古霉素相关性TEN的报道一致。任何在接受万古霉素治疗时发生TEN的患者都应评估是否可能为万古霉素诱发的TEN。
