James Jared, Sammour Yasser M, Virata Andrew R, Nordin Terri A, Dumic Igor
Mayo Clinic Family Medicine Residency Program, Mayo Clinic Health System, Eau Claire, WI, USA.
Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Am J Case Rep. 2018 Feb 14;19:163-170. doi: 10.12659/ajcr.907464.
BACKGROUND DRESS is a rare, life threatening syndrome that occurs following exposure to certain medications, most commonly antibiotics and antiepileptics. While sulfonamide antibiotics are frequently implicated as causative agents for DRESS syndrome, furosemide, a nonantibiotic sulfonamide, has not been routinely reported as the causative agent despite its widespread use. CASE REPORT A 63 year old male who started furosemide for lower extremity edema 10 weeks prior presented with diarrhea, fever of 39.4°C, dry cough and maculopapular rash involving >50% of his body. He self-discontinued furosemide due to concern for dehydration. The diarrhea spontaneously resolved, but he developed hypoxia requiring hospitalization. CT scan demonstrated mediastinal lymphadenopathy and interstitial infiltrates. Laboratory evaluation revealed leukocytosis, eosinophilia and thrombocytopenia. He was treated empirically for atypical pneumonia, and after resuming furosemide for fluid excess, he developed AKI, worsening rash, fever and eosinophilia of 2,394 cell/µL. Extensive infectious and inflammatory work up was negative. Skin biopsy was consistent with a severe drug reaction. Latency from introduction and clinical worsening following re-exposure indicated furosemide was the likely inciter of DRESS. The RegiSCAR scoring system categorized this case as "definite" with a score of 8. CONCLUSIONS We report a case of severe DRESS syndrome secondary to furosemide, only the second case report in medical literature implicating furosemide. Given its widespread use, the potentially life-threatening nature of DRESS syndrome and the commonly delayed time course in establishing the diagnosis, it is important to remember that, albeit rare, furosemide can be a cause of DRESS syndrome.
背景 药物超敏反应伴嗜酸性粒细胞增多和系统症状（DRESS）是一种罕见的、危及生命的综合征，发生于接触某些药物后，最常见的是抗生素和抗癫痫药。虽然磺胺类抗生素常被认为是DRESS综合征的致病因素，但速尿作为一种非抗生素类磺胺，尽管广泛使用，却尚未被常规报道为致病因素。病例报告 一名63岁男性，10周前因下肢水肿开始服用速尿，出现腹泻、39.4℃发热、干咳以及累及身体超过50%的斑丘疹。由于担心脱水，他自行停用了速尿。腹泻自行缓解，但他出现缺氧，需要住院治疗。CT扫描显示纵隔淋巴结肿大和间质浸润。实验室检查显示白细胞增多、嗜酸性粒细胞增多和血小板减少。他接受了非典型肺炎的经验性治疗，在因液体过多重新服用速尿后，他出现了急性肾损伤、皮疹加重、发热以及嗜酸性粒细胞增多至2394个/微升。广泛的感染和炎症检查均为阴性。皮肤活检与严重药物反应一致。从初次用药到再次接触后临床恶化的潜伏期表明速尿可能是DRESS的诱发因素。RegiSCAR评分系统将该病例归类为“确诊”，得分为8分。结论 我们报告了一例由速尿引起的严重DRESS综合征病例，这是医学文献中第二例涉及速尿的病例报告。鉴于其广泛使用、DRESS综合征潜在的危及生命的性质以及诊断通常延迟的病程，重要的是要记住，尽管罕见，但速尿可能是DRESS综合征的一个病因。
