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环丙沙星诱发的史蒂文斯-约翰逊综合征与饮用葡萄柚汁:一例报告

Ciprofloxacin-induced Stevens-Johnson Syndrome with Grapefruit Juice Consumption: A Case Report.

作者信息

Cravens Matthew G, Sherman Nathan, Sawaya Jennifer

机构信息

Emergency Medicine, University of Arizona College of Medicine, Tucson, USA.

Internal Medicine, University of Arizona College of Medicine, Tucson, USA.

出版信息

Cureus. 2019 Jan 4;11(1):e3827. doi: 10.7759/cureus.3827.

Abstract

We describe the case of a 49-year-old, otherwise healthy, Hispanic male who underwent an uncomplicated vasectomy and was treated prophylactically with a one-week course of ciprofloxacin. Two days after completing the antibiotic course, he developed a pruritic, blistering rash that covered 90% of his body surface area. Punch biopsy of the skin lesions confirmed the diagnosis of Stevens-Johnson syndrome (SJS). Upon further questioning, it was revealed that the patient had consumed approximately 32 ounces of grapefruit juice each of the seven days following his vasectomy. We hypothesized that the cytochrome P450 inhibitory effect of grapefruit juice had dramatically elevated systemic levels of ciprofloxacin, increasing the risk of developing SJS. Literature review revealed that ciprofloxacin is metabolized primarily by CYP1A2 with partial CYP3A4 metabolism, while grapefruit juice is strictly an enterocyte CYP3A4 inhibitor. To the authors' knowledge, consumption of grapefruit juice has never been demonstrated to increase systemic levels of ciprofloxacin or of other fluoroquinolones. We conclude that either this is the first reported case of a grapefruit juice-ciprofloxacin interaction causing SJS, or that this is simply ciprofloxacin-induced SJS. Importantly, ciprofloxacin is not recommended by the American Urological Association for a routine vasectomy without risk factors for infection. We remind clinicians that inappropriately prescribed antibiotic prophylaxis for routine procedures can cause serious morbidity, including SJS, and should only be prescribed when indicated.

摘要

我们描述了一名49岁、身体健康的西班牙裔男性病例,他接受了一次简单的输精管切除术,并接受了为期一周的环丙沙星预防性治疗。在完成抗生素疗程两天后,他出现了瘙痒性水疱皮疹,覆盖了身体表面积的90%。皮肤病变的打孔活检确诊为史蒂文斯-约翰逊综合征(SJS)。进一步询问后发现,该患者在输精管切除术后的七天里,每天大约饮用32盎司葡萄柚汁。我们推测,葡萄柚汁对细胞色素P450的抑制作用显著提高了环丙沙星的全身水平,增加了发生SJS的风险。文献综述显示,环丙沙星主要通过CYP1A2代谢,部分通过CYP3A4代谢,而葡萄柚汁是一种严格的肠细胞CYP3A4抑制剂。据作者所知,饮用葡萄柚汁从未被证明会增加环丙沙星或其他氟喹诺酮类药物的全身水平。我们得出结论,要么这是首例报告的因葡萄柚汁-环丙沙星相互作用导致SJS的病例,要么这仅仅是环丙沙星引起的SJS。重要的是,美国泌尿外科学会不建议在无感染危险因素的情况下对常规输精管切除术常规使用环丙沙星。我们提醒临床医生,为常规手术不恰当地开具抗生素预防性用药可能会导致严重的发病率,包括SJS,并且仅应在有指征时开具。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/916c/6402866/e554f1321d2b/cureus-0011-00000003827-i01.jpg

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