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别嘌醇致 Stevens-Johnson 综合征

Allopurinol-Induced Stevens-Johnson Syndrome.

机构信息

Department of Pulmonary and Critical Care Medicine.

Department of Internal Medicine.

出版信息

Am J Med Sci. 2019 Apr;357(4):348-351. doi: 10.1016/j.amjms.2018.11.018. Epub 2018 Dec 4.

Abstract

Allopurinol is a first line agent in treating gout, but it also carries the risk of severe side effects. Stevens-Johnson syndrome (SJS) is one of the life threatening severe cutaneous adverse reactions caused by allopurinol. The severity of the severe cutaneous adverse reactions can be categorized based upon the area of skin involvement: (1) erythema multiforme major limited to 1-2 % of the body surface area (BSA); (2) SJS involving <10% of the BSA, (3) SJS and toxic epidermal necrolysis overlap involving 10-30% of the BSA and (4) toxic epidermal necrolysis syndrome involving >30% of the BSA. SJS can be caused by drugs and viruses, the former being more frequent. We report a case of an 85-year-old Han-Chinese female who developed SJS after ingestion of allopurinol 8 days prior to the hospitalization. The patient also had concomitant acute viral illness, which complicated the clinical scenario causing acute renal failure and hemodynamic compromise.

摘要

别嘌醇是治疗痛风的一线药物,但它也有发生严重副作用的风险。史蒂文斯-约翰逊综合征(SJS)是别嘌醇引起的危及生命的严重皮肤不良反应之一。严重皮肤不良反应的严重程度可根据皮肤受累面积进行分类:(1)累及 1-2%体表面积(BSA)的大形多形红斑;(2)累及<10%BSA 的 SJS;(3)SJS 与中毒性表皮坏死松解症重叠,累及 10-30%BSA;(4)累及>30%BSA 的中毒性表皮坏死松解症综合征。SJS 可由药物和病毒引起,前者更为常见。我们报告了一例 85 岁汉族女性,在入院前 8 天服用别嘌醇后发生 SJS。该患者同时患有急性病毒性疾病,使临床情况复杂化,导致急性肾衰竭和血流动力学不稳定。

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