Patterson R, Dykewicz M S, Gonzalzles A, Grammer L C, Green D, Greenberger P A, McGrath K G, Walker C L
Department of Medicine, Northwestern University Medical School, Chicago.
Chest. 1990 Aug;98(2):331-6. doi: 10.1378/chest.98.2.331.
Diagnosis and particularly the management of erythema multiforme and Stevens-Johnson syndrome are controversial in medical textbooks and thus in individual cases. In these diseases, fatalities may result from various causes, including secondary infection or visceral organ damage to lung, liver, or kidneys. We present a series of 13 cases managed by one group of physicians which demonstrates the controversy in certain cases, and we review the controversy in the medical literature. Corticosteroid therapy used in this series was considered beneficial in every case by the managing physician and lifesaving in some cases. There were no fatalities in this series. Although the summation may be considered as our opinion only, the frequently suggested "controlled trial of corticosteroid therapy" can probably never be done for ethical reasons, and series such as this will have to establish the standard of therapy.
多形红斑和史蒂文斯-约翰逊综合征的诊断,尤其是其治疗方法,在医学教科书中存在争议,在个别病例中亦是如此。在这些疾病中,死亡可能由多种原因导致,包括继发感染或肺、肝、肾等内脏器官损害。我们展示了一组医生管理的13个病例系列,这体现了某些病例中的争议所在,并且我们回顾了医学文献中的争议。在这个病例系列中使用的皮质类固醇疗法,主治医生认为在每个病例中都有益处,在某些病例中甚至是救命的。这个病例系列中没有死亡病例。尽管这些总结可能仅被视为我们的观点,但出于伦理原因,经常被提及的“皮质类固醇疗法对照试验”可能永远无法进行,而像这样的病例系列将不得不确立治疗标准。