Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada2Division of Dermatology, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada.
JAMA Dermatol. 2016 Nov 1;152(11):1254-1257. doi: 10.1001/jamadermatol.2016.2220.
Drug-induced hypersensitivity syndrome (DIHS), also known as drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, is a potentially life-threatening reaction to medications with a mortality rate up to 10%. Standard therapy involves the use of systemic corticosteroids with tapering doses extending up to 9 months after the initial reaction. Alternative treatments for DIHS are needed, especially for patients for whom systemic corticosteroids are contraindicated.
To assess a short course of cyclosporine as first-line therapy for DIHS.
DESIGN, SETTING, AND PARTICIPANTS: In this case series, 2 patients referred to the dermatology service of an academic tertiary care hospital and subsequently diagnosed as having DIHS were studied from December 1, 2013, through July 31, 2014.
Short course (3-7 days) of cyclosporine.
Clinical and laboratory indicators were examined to determine the timing and efficacy of cyclosporine treatment.
Two cases are reported of drug hypersensitivity reaction that were treated with cyclosporine, resulting in rapid and significant clinical improvement. The first case involved a woman in her 40s who developed DIHS after treatment with carbamazepine. A 7-day course of cyclosporine resulted in clinical resolution of the DIHS. The second case was that of a man in his 30s with minocycline-induced DIHS. A 3-day course of cyclosporine resulted in rapid and sustained clinical improvement.
A short course of cyclosporine was of therapeutic benefit in the treatment of 2 patients with DIHS. Short courses of cyclosporine in the acute care setting may be an alternative to longer courses of systemic corticosteroids in the treatment of DIHS.
药物诱导的超敏反应综合征（DIHS），也称为药物反应伴嗜酸性粒细胞增多和全身症状（DRESS）综合征，是一种潜在的危及生命的药物反应，死亡率高达 10%。标准治疗包括使用全身皮质类固醇，剂量逐渐减少，持续时间长达初始反应后 9 个月。需要寻找 DIHS 的替代治疗方法，尤其是对于全身皮质类固醇禁忌的患者。
评估环孢素短期疗程作为 DIHS 的一线治疗。
设计、地点和参与者：在这项病例系列研究中，2013 年 12 月 1 日至 2014 年 7 月 31 日，我们研究了 2 名转诊至学术三级保健医院皮肤科服务的患者，随后诊断为 DIHS。
环孢素短期疗程（3-7 天）。
检查临床和实验室指标以确定环孢素治疗的时间和疗效。
报告了 2 例药物超敏反应病例，用环孢素治疗，迅速显著改善临床症状。第一例为 40 多岁女性，因服用卡马西平而出现 DIHS。7 天的环孢素疗程导致 DIHS 临床缓解。第二例为 30 多岁男性，因服用米诺环素而出现 DIHS。3 天的环孢素疗程导致快速和持续的临床改善。
短期环孢素疗程对 2 例 DIHS 患者有治疗益处。在急性护理环境中，短期环孢素疗程可能是替代长期全身皮质类固醇治疗 DIHS 的方法。
