Chongqing Medical University, Yuzhong District, Chongqing, China.
Department of Geriatric, Chongqing General Hospital, Chongqing University, Yuzhong District, Chongqing, China.
Medicine (Baltimore). 2024 Sep 27;103(39):e39715. doi: 10.1097/MD.0000000000039715.
Drug hypersensitivity syndrome (DIHS) is a rare but potentially fatal adverse drug reaction characterized by fever, rash, and visceral organ damage, particularly affecting the liver. Early recognition and appropriate management are crucial to prevent serious complications. However, there is limited information on the clinical presentation and management of DIHS, especially in the context of antiepileptic drugs. This case report aims to highlight the importance of recognizing subtle clinical signs and symptoms of DIHS, which can be easily overlooked, particularly in the context of antiepileptic drug use.
We report a case of a 15-year-old male patient who developed DIHS after being prescribed phenytoin sodium for epilepsy. The patient presented with symptoms of fever, sore throat, rash, jaundice, and liver dysfunction. Initially, the patient did not receive glucocorticoids and experienced additional reactions to cefoxitin and phosphatidylcholine, likely due to cross-reactivity.
The diagnosis of DIHS was made based on the patient's clinical presentation, including fever, extensive rash, organ involvement, and hematological abnormalities. The temporal association with the use of phenytoin sodium, along with the exclusion of other causes of fever and rash, supported the diagnosis.
Upon initiation of glucocorticoid therapy with dexamethasone, the patient's symptoms significantly improved. The rash and pruritus decreased, and laboratory values showed improvement, with a decrease in liver enzymes and normalization of white blood cell counts.
The patient's fever resolved within 48 hours of starting corticosteroids, and there was no evidence of ongoing inflammation as indicated by a decrease in C-reactive protein levels. Furthermore, the patient's 30-month follow-up revealed no recurrence of rash, liver dysfunction, or organic damage, indicating the long-term effectiveness of the treatment administered.
This case highlights the importance of recognizing the subtle clinical signs and symptoms of DIHS, especially in the context of antiepileptic drug use. It underscores the potential benefits of early initiation of glucocorticoid therapy in managing DIHS. The case also serves as a reminder of the potential for drug cross-reactivity in DIHS and the need for cautious drug selection during the acute phase of the syndrome.
药物超敏反应综合征（DIHS）是一种罕见但潜在致命的药物不良反应，其特征为发热、皮疹和内脏器官损伤，尤其影响肝脏。早期识别和适当的管理对于预防严重并发症至关重要。然而，关于 DIHS 的临床表现和管理的信息有限，尤其是在抗癫痫药物的背景下。本病例报告旨在强调识别 DIHS 细微临床体征和症状的重要性，这些症状可能很容易被忽视，尤其是在使用抗癫痫药物的情况下。
我们报告了一例 15 岁男性患者，他在服用苯妥英钠治疗癫痫后发生 DIHS。患者出现发热、咽痛、皮疹、黄疸和肝功能障碍的症状。最初，患者未接受糖皮质激素治疗，并且对头孢西丁和磷脂酰胆碱产生了额外的反应，可能是由于交叉反应。
根据患者的临床表现，包括发热、广泛皮疹、器官受累和血液学异常，诊断为 DIHS。与苯妥英钠使用的时间关联，以及排除其他发热和皮疹的原因，支持了该诊断。
开始用地塞米松进行糖皮质激素治疗后，患者的症状显著改善。皮疹和瘙痒减轻，实验室值显示改善，肝酶降低，白细胞计数正常化。
患者在开始使用皮质类固醇后 48 小时内退热，C 反应蛋白水平下降表明炎症没有持续。此外，患者的 30 个月随访显示无皮疹、肝功能障碍或器官损伤复发，表明治疗效果长期有效。
本病例强调了识别 DIHS 细微临床体征和症状的重要性，尤其是在抗癫痫药物使用的背景下。它突出了早期开始糖皮质激素治疗管理 DIHS 的潜在益处。该病例还提醒人们注意 DIHS 中药物交叉反应的可能性，以及在综合征的急性期谨慎选择药物的必要性。
