Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2010 Jan;25(1):148-51. doi: 10.3346/jkms.2010.25.1.148. Epub 2009 Dec 29.
An 82-yr-old man was presented with fever and cough accompanied by generalized erythematous rash. He had taken mexiletine for 5 months, as he had been diagnosed with dilated cardiomyopathy and ventricular arrhythmia. Laboratory studies showed peripheral blood eosinophilia and elevated liver transaminase levels. Chest radiographs showed multiple nodular consolidations in both lungs. Biopsies of the lung and skin lesions revealed eosinophilic infiltration. After a thorough review of his medication history, mexiletine was suspected as the etiologic agent. After discontinuing the mexiletine and starting oral prednisolone, the patient improved, and the skin and lung lesions disappeared. Subsequently, mexiletine was confirmed as the causative agent based on a positive patch test. Drug-induced hypersensitivity syndrome is a severe adverse reaction to drugs and results from treatment with anticonvulsants, allopurinol, sulfonamides, and many other drugs. Several cases of mexiletine-induced hypersensitivity syndrome have been reported in older Japanese males with manifestation of fever, rash, peripheral blood eosinophilia, liver dysfunction without other organ involvement. Here, we report a case of mexiletine-induced hypersensitivity syndrome which presented as eosinophilic pneumonia in a Korean male.
一位 82 岁男性因发热、咳嗽伴全身红斑就诊。他因扩张型心肌病和室性心律失常已服用美西律 5 个月。实验室检查示外周血嗜酸性粒细胞增多和肝转氨酶升高。胸部 X 线片显示双肺多发结节状实变影。肺和皮肤病变活检显示嗜酸性粒细胞浸润。仔细询问其用药史后，怀疑美西律是致病药物。停用美西律并开始口服泼尼松龙后，患者病情改善，皮肤和肺部病变消失。随后，斑贴试验阳性证实美西律是致病药物。药物超敏反应综合征是一种严重的药物不良反应，与抗惊厥药、别嘌醇、磺胺类药物及其他许多药物有关。已有几例美西律引起的药物超敏反应综合征在老年日本男性中报道，表现为发热、皮疹、外周血嗜酸性粒细胞增多、肝功能异常而无其他器官受累。本文报道了 1 例韩国男性美西律引起的嗜酸性粒细胞性肺炎。
