Sato Hirotaka, Takase Kentaro, Harada Aiko, Ozono Iori, Kodama Yasuhide, Ishitobi Tomoko, Imada Toshihiro, Ohnuma Hideyuki, Kin Seikon
Department of Nephrology, Shimane Prefectural Central Hospital, Japan.
Department of General Medicine, Shimane Prefectural Central Hospital, Japan.
Intern Med. 2022 Oct 1;61(19):2911-2916. doi: 10.2169/internalmedicine.8985-21. Epub 2022 Feb 26.
A 59-year-old man undergoing hemodialysis was administered levetiracetam, after which he developed a systemic rash, high fever, severe liver dysfunction, and leukocytopenia with reactivation of human herpes virus 6. Atypical drug-induced hypersensitivity (DIHS) was diagnosed, and prednisolone was administered at 60 mg/day. However, liver failure rapidly progressed, and the patient died 12 days following treatment. Despite the rarity of DIHS with concomitant fulminant liver failure from levetiracetam and sufficient clearance thereof by hemodialysis, our case suggests that this syndrome may still ensue, resulting in mortality, even in hemodialysis patients. Although no treatment has yet been established, strict monitoring and aggressive treatment may be required.
一名59岁接受血液透析的男性患者使用了左乙拉西坦，之后出现全身性皮疹、高热、严重肝功能障碍以及白细胞减少，同时人疱疹病毒6再次激活。诊断为非典型药物性超敏反应（DIHS），给予泼尼松龙60mg/天治疗。然而，肝功能衰竭迅速进展，患者在治疗12天后死亡。尽管左乙拉西坦导致的DIHS伴发暴发性肝衰竭罕见，且血液透析能充分清除该药物，但我们的病例提示，即使在血液透析患者中，这种综合征仍可能发生并导致死亡。虽然尚未确立治疗方法，但可能需要严格监测和积极治疗。
