Baetz Brooke E, Patton Mary Lou, Guilday Robert E, Reigart Cynthia L, Ackerman Bruce H
University of Maryland Medical Center, Baltimore, USA.
J Burn Care Res. 2011 Sep-Oct;32(5):e158-60. doi: 10.1097/BCR.0b013e31822ac7be.
The objective of this study is to report a case of amlodipine-induced dermatotoxicity following treatment for diabetic nephropathy. Although other members of the dihydropyridine calcium channel blockers have been reported to cause dermatotoxic reactions, this is the first report attributing this effect to amlodipine. A 71-year-old diabetic and hypertensive woman had been noted to have worsened renal dysfunction and hyperkalemia attributed to enalapril, thus a trial of amlodipine was begun. On day 12 of amlodipine therapy, the patient developed a pruritic maculopapular rash on her hands for which she sought medical attention. On day 16, she presented again to the emergency department now with hives and small blisters involving the trunk and arms with ∼25% TBSA involvement warranting transfer to a regional burn treatment center. The rash progressed after admission to 48.5% TBSA and included conjunctival sloughing. The patient's hospital course was uneventful, and she was discharged after 8 days. Drug-induced dermatotoxicity presenting as toxic epidermal necrolysis is often caused by antibiotics and antiepileptic medications; however, calcium channel blockers are an uncommon cause. The Naranjo assessment yielded a score of 5, and the SCORTEN was 4 with a predicted mortality of 58%. This report represents the first published case of amlodipine-induced toxic epidermal necrolysis.
本研究的目的是报告一例糖尿病肾病治疗后氨氯地平诱发的皮肤毒性反应。尽管已有报道称二氢吡啶类钙通道阻滞剂的其他成员可引起皮肤毒性反应，但这是首例将这种效应归因于氨氯地平的报告。一名71岁的糖尿病和高血压女性患者，因依那普利导致肾功能不全和高钾血症加重，因此开始试用氨氯地平。在氨氯地平治疗的第12天，患者双手出现瘙痒性斑丘疹，为此她寻求医疗帮助。第16天，她再次前往急诊科，此时出现荨麻疹和小水泡，累及躯干和手臂，体表面积累及约25%，需要转至地区烧伤治疗中心。入院后皮疹进展至体表面积的48.5%，并出现结膜脱落。患者的住院过程平稳，8天后出院。药物性皮肤毒性表现为中毒性表皮坏死松解症，通常由抗生素和抗癫痫药物引起；然而，钙通道阻滞剂是一种罕见的病因。Naranjo评估得分为5分，SCORTEN评分为4分，预测死亡率为58%。本报告是首例发表的氨氯地平诱发中毒性表皮坏死松解症的病例。
