Pinna Martina, Manchia Mirko, Puddu Sergio, Minnai Giampaolo, Tondo Leonardo, Salis Piergiorgio
Psychiatry Unit, San Martino Hospital-Regional Health Agency, Oristano, Sardinia, Italy.
Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Via Liguria, 13, 09127, Cagliari, Sardinia, Italy.
Int J Bipolar Disord. 2017 Dec;5(1):20. doi: 10.1186/s40345-017-0091-7. Epub 2017 Jul 4.
To present a new case of adverse cutaneous reaction during lithium treatment and to update the systematic review and meta-analysis of the incidence of this adverse reaction.
We conducted a systematic search (performed in September 2016) for peer-reviewed articles in English indexed in Medline (2011-present). Meta-analytical estimates were obtained using the "Metafor" package.
Ms. H., a 31-year-old Caucasian woman with BD1, was admitted to the inpatient unit for a full-blown psychotic episode and treated with carbamazepine 400 mg q.d., lithium carbonate 450 mg q.d., and risperidone 4 mg q.d. with clinical improvement. After 12 days from the start of psychopharmacological treatment, she manifested a cutaneous reaction that motivated the stop of carbamazepine treatment, as well as the increase in lithium carbonate dose (750 mg q.d.). Risperidone dose remained unvaried. Since the skin lesion persisted after 8 days from withdrawal of carbamazepine, the private practitioner stopped also lithium carbonate treatment (de-challenge), maintaining risperidone treatment. The cutaneous reaction resolved spontaneously after six days from withdrawal of lithium carbonate. Subsequently, the worsening of psychopathological conditions motivated a new admission during which lithium carbonate was reintroduced (16 days after its suspension) (re-challenge). On the following day, we observed an itching erythematous maculopapular rash involving the trunk, the four limbs, and the oral mucosa.
Our case of an erythematous maculopapular rash during lithium treatment was the first to present a challenge-de-challenge-re-challenge sequence that suggests causality. Although meta-analysis does not point to an increased rate of adverse skin reaction during lithium treatment, clinicians should not neglect to monitor cutaneous symptoms during lithium treatment.
报告1例锂盐治疗期间出现的皮肤不良反应新病例，并更新该不良反应发生率的系统评价和荟萃分析。
我们（于2016年9月）在Medline（2011年至今）索引的英文同行评审文章中进行了系统检索。使用“Metafor”软件包获得荟萃分析估计值。
H女士，一名31岁的白种BD1型双相情感障碍女性，因全面性精神病发作入住住院部，接受卡马西平400mg每日一次、碳酸锂450mg每日一次及利培酮4mg每日一次治疗，临床症状改善。在开始精神药物治疗12天后，她出现皮肤反应，促使停用卡马西平治疗，并增加碳酸锂剂量（至750mg每日一次）。利培酮剂量保持不变。由于停用卡马西平8天后皮肤损害仍持续存在，私人执业医生也停用了碳酸锂治疗（撤药），继续使用利培酮治疗。停用碳酸锂6天后皮肤反应自发消退。随后，精神病理状况恶化促使再次入院，在此期间重新引入碳酸锂（停用16天后）（再激发）。次日，我们观察到躯干、四肢及口腔黏膜出现瘙痒性红斑丘疹皮疹。
我们报告的锂盐治疗期间出现红斑丘疹皮疹的病例是首例呈现激发 - 撤药 - 再激发序列提示因果关系的病例。尽管荟萃分析未表明锂盐治疗期间皮肤不良反应发生率增加，但临床医生在锂盐治疗期间不应忽视监测皮肤症状。
