Raviglione M C, Dinan W A, Pablos-Mendez A, Palagiano A, Sabatini M T
Department of Medicine, Cabrini Medical Center, New York, NY 10003.
Arch Intern Med. 1988 Dec;148(12):2683-5.
The combination of pyrimethamine and sulfadoxine (Fansidar) has been reported to cause severe skin reactions including erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis. Recently, this drug combination has been used for prophylaxis of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome. After two months of weekly prophylaxis with pyrimethamine and sulfadoxine, a 48-year-old homosexual man who was antibody positive for human immunodeficiency virus developed severe widespread erythema, blisters, and loss of skin in sheets, and subsequently died. To our knowledge, this is the first reported case of fatal toxic epidermal necrolysis occurring in a patient with acquired immunodeficiency syndrome-related complex. The lack of absolute safety of prophylaxis with pyrimethamine and sulfadoxine is emphasized in our case, and mandates cautious use and the consideration of less toxic prophylactic measures such as therapy with the recently introduced aerosolized pentamidine.
据报道，乙胺嘧啶和磺胺多辛（Fansidar）联用可引起严重的皮肤反应，包括多形红斑、史蒂文斯－约翰逊综合征和中毒性表皮坏死松解症。近来，这种药物联用已被用于获得性免疫缺陷综合征患者卡氏肺孢子虫肺炎的预防。在用乙胺嘧啶和磺胺多辛进行每周一次的预防治疗两个月后，一名48岁的同性恋男子出现严重的全身性红斑、水疱及大片皮肤脱落，随后死亡。该男子为人类免疫缺陷病毒抗体阳性。据我们所知，这是首例有报道的发生于获得性免疫缺陷综合征相关综合征患者的致命性中毒性表皮坏死松解症。我们的病例强调了乙胺嘧啶和磺胺多辛预防用药并非绝对安全，这就要求谨慎使用，并考虑采用毒性较小的预防措施，如使用最近推出的雾化喷他脒进行治疗。
