Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China.
Department of Geriatrics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China.
J Int Med Res. 2020 May;48(5):300060520922416. doi: 10.1177/0300060520922416.
A 56-year-old man diagnosed with non-Hodgkin's lymphoma underwent autologous bone marrow transplantation. He was subsequently admitted to the hospital with fever, and his symptoms were initially controlled by multiple antibiotics, including tigecycline. He then developed a generalized body rash that improved after treatment with anti-allergy drugs and steroids. Furthermore, tigecycline treatment for a second time resulted in a severe skin reaction with systemic symptoms, suggesting toxic epidermal necrolysis syndrome (TEN). The patient was shown to have the slow-metabolizing cytochrome P450 2C19 allele, denoted CYP2C19*2. He was transferred to a laminar flow ward and given strict mucosal care, together with corticosteroids and intravenous immunoglobulin. He recovered after 3 weeks of treatment. Tigecycline-induced Stevens-Johnson syndrome (SJS)/TEN has rarely been reported in the Chinese population. However, our experience suggests that Asians are more likely to have adverse reactions to drugs metabolized by the cytochrome P450 enzyme. Early identification of drug reactions and immediate cessation of the suspected drug is essential. Additionally, a combined therapy scheme and a clean laminar flow environment may improve the cure rate of SJS/TEN.
一位 56 岁男性被诊断患有非霍奇金淋巴瘤，接受了自体骨髓移植。随后他因发热住院，最初通过多种抗生素（包括替加环素）治疗控制了症状。之后他出现全身皮疹，经抗过敏药物和类固醇治疗后改善。此外，第二次使用替加环素治疗后出现伴有全身症状的严重皮肤反应，提示中毒性表皮坏死松解症（TEN）。患者携带细胞色素 P450 2C19 慢代谢等位基因，命名为 CYP2C19*2。他被转至层流病房，接受严格的黏膜护理、皮质类固醇和静脉注射免疫球蛋白治疗。经过 3 周治疗后康复。替加环素诱导的史蒂文斯-约翰逊综合征（SJS）/TEN 在中国人中很少见。然而，我们的经验表明，亚洲人更有可能对细胞色素 P450 酶代谢的药物产生不良反应。早期识别药物反应并立即停用可疑药物至关重要。此外，联合治疗方案和清洁的层流环境可能提高 SJS/TEN 的治愈率。
