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安乃近诱导的史蒂文斯-约翰逊综合征。

Dipyrone (Metamizole)-Induced Stevens-Johnson Syndrome.

作者信息

Gomes Ferreira Sérgio, Fernandes Luís, Santos Sara, Ferreira Sofia, Sequeira Joana

机构信息

Internal Medicine, Hospital São Sebastião, Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, PRT.

出版信息

Cureus. 2024 Jan 28;16(1):e53122. doi: 10.7759/cureus.53122. eCollection 2024 Jan.

DOI:10.7759/cureus.53122
PMID:38420072
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10899118/
Abstract

Stevens-Johnson Syndrome (SJS), a severe mucocutaneous hypersensitivity reaction primarily triggered by drugs, poses a low-incidence, high-mortality challenge. This report explores its clinical nuances and emphasizes supportive care as the mainstay of treatment. A 74-year-old female, burdened with a complex medical history, presented with a non-pruritic macular rash escalating to skin and oral mucosal involvement. A recent introduction of dipyrone (metamizole) implicated drug-induced SJS. Histopathological confirmation guided treatment involving supportive care, corticosteroids, and wound care, resulting in clinical improvement. The case underscores the significance of histopathological confirmation and thorough medication history in navigating SJS complexities, especially in patients with comorbidities like connective tissue disease. A successful multidisciplinary approach and the decision for post-discharge monitoring highlight the intricate management challenges. This case illuminates the intricate interplay of medication-induced hypersensitivity, comorbidities, and management challenges in SJS. Optimal outcomes require prompt diagnosis, trigger identification, and a multidisciplinary treatment approach, emphasizing ongoing research and clinical vigilance.

摘要

史蒂文斯 - 约翰逊综合征(SJS)是一种主要由药物引发的严重皮肤黏膜超敏反应,是一种低发病率、高死亡率的挑战。本报告探讨其临床细微差别,并强调支持性护理是治疗的主要手段。一名74岁女性,有复杂的病史,最初出现非瘙痒性黄斑皮疹,随后发展为皮肤和口腔黏膜受累。最近使用的安乃近(甲氨唑)被认为是药物性SJS的诱因。组织病理学确诊后,治疗包括支持性护理、皮质类固醇和伤口护理,临床症状得到改善。该病例强调了组织病理学确诊和详尽用药史在应对SJS复杂性方面的重要性,尤其是对于患有结缔组织病等合并症的患者。成功的多学科方法以及出院后监测的决定凸显了复杂的管理挑战。该病例阐明了药物性超敏反应、合并症和SJS管理挑战之间的复杂相互作用。最佳治疗效果需要及时诊断、确定诱因以及采取多学科治疗方法,强调持续研究和临床警惕性。

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Epidemiological Characteristics and Prognostic Scoring in Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome: Insights from a 17-Year Burn Center Experience.中毒性表皮坏死松解症和史蒂文斯-约翰逊综合征的流行病学特征及预后评分:来自一家烧伤中心17年经验的见解
Medicina (Kaunas). 2025 Jan 3;61(1):66. doi: 10.3390/medicina61010066.

本文引用的文献

1
Recent advances in managing and understanding Stevens-Johnson syndrome and toxic epidermal necrolysis.史蒂文斯-约翰逊综合征和中毒性表皮坏死松解症管理与认识的最新进展
F1000Res. 2020 Jun 16;9. doi: 10.12688/f1000research.24748.1. eCollection 2020.
2
Current Perspectives on Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis.史蒂文斯-约翰逊综合征和中毒性表皮坏死松解症的最新观点。
Clin Rev Allergy Immunol. 2018 Feb;54(1):147-176. doi: 10.1007/s12016-017-8654-z.
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Severe cutaneous adverse reactions to drugs.药物严重皮肤不良反应。
Lancet. 2017 Oct 28;390(10106):1996-2011. doi: 10.1016/S0140-6736(16)30378-6. Epub 2017 May 2.
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Long-term complications of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN): the spectrum of chronic problems in patients who survive an episode of SJS/TEN necessitates multidisciplinary follow-up.史蒂文斯-约翰逊综合征/中毒性表皮坏死松解症(SJS/TEN)的长期并发症:存活 SJS/TEN 发作的患者存在一系列慢性问题,需要多学科随访。
Br J Dermatol. 2017 Oct;177(4):924-935. doi: 10.1111/bjd.15360. Epub 2017 Sep 22.
5
U.K. guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults 2016.《2016年英国成人史蒂文斯-约翰逊综合征/中毒性表皮坏死松解症管理指南》
Br J Dermatol. 2016 Jun;174(6):1194-227. doi: 10.1111/bjd.14530.
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Comprehensive survival analysis of a cohort of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis.史蒂文斯-约翰逊综合征和中毒性表皮坏死松解症患者队列的综合生存分析。
J Invest Dermatol. 2013 May;133(5):1197-204. doi: 10.1038/jid.2012.510. Epub 2013 Feb 7.
7
Stevens-Johnson syndrome and toxic epidermal necrolysis in patients with lupus erythematosus: a descriptive study of 17 cases from a national registry and review of the literature.红斑狼疮患者的史蒂文斯-约翰逊综合征和中毒性表皮坏死松解症:来自国家登记处的 17 例描述性研究及文献复习。
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Effects of treatments on the mortality of Stevens-Johnson syndrome and toxic epidermal necrolysis: A retrospective study on patients included in the prospective EuroSCAR Study.治疗对史蒂文斯-约翰逊综合征和中毒性表皮坏死松解症死亡率的影响:一项针对纳入前瞻性欧洲严重皮肤不良反应研究(EuroSCAR Study)患者的回顾性研究。
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