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克林霉素引起的严重皮肤反应:中毒性表皮坏死松解症1例报告

Severe Cutaneous Reaction Induced by Clindamycin: A Case Report of Toxic Epidermal Necrolysis.

作者信息

Scally Gabriel, Haile Yohannes, Seylani Allen, Sheets Nicholas W

机构信息

General Surgery, Riverside Community Hospital, Riverside, USA.

Surgery, University of California Riverside School of Medicine, Riverside, USA.

出版信息

Cureus. 2024 Sep 24;16(9):e70098. doi: 10.7759/cureus.70098. eCollection 2024 Sep.

Abstract

Toxic epidermal necrolysis (TEN) is a rare, acute inflammatory skin reaction that results in skin blistering and extensive epidermal detachment. Stevens-Johnson syndrome (SJS) and TEN are unified aspects on a spectrum varying in the severity of vesiculobullous cutaneous eruptions with mucosal involvement of the oral cavity, genitourinary tract, gastrointestinal tract, and conjunctiva. The inciting event is usually caused by an exaggerated hypersensitivity reaction in response to triggering medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, urate-lowering drugs (such as allopurinol), anticonvulsants, and antipsychotics. We report a case of clindamycin-induced TEN in a 79-year-old African-American female following the recent administration of clindamycin for a developing sacral decubitus ulcer. However, lincosamide antibiotics like clindamycin are rarely associated with precipitating SJS or TEN. This report highlights the treatment and prognostic challenges faced throughout the patient's clinical course and seeks to highlight the importance of recognizing the development of SJS/TEN following novel drug administration and promptly addressing the management of the condition to improve long-term patient outcomes.

摘要

中毒性表皮坏死松解症(TEN)是一种罕见的急性炎症性皮肤反应,可导致皮肤水疱形成和广泛的表皮剥脱。史蒂文斯-约翰逊综合征(SJS)和TEN是同一谱系中不同严重程度的水疱性皮肤疹的统一表现,伴有口腔、泌尿生殖道、胃肠道和结膜的黏膜受累。引发事件通常是由对触发药物的过度超敏反应引起的,这些药物包括非甾体抗炎药(NSAIDs)、抗生素、降尿酸药物(如别嘌醇)、抗惊厥药和抗精神病药。我们报告了一例79岁非裔美国女性因近期使用克林霉素治疗骶部压疮而发生克林霉素诱导的TEN病例。然而,像克林霉素这样的林可酰胺类抗生素很少与SJS或TEN的发生有关。本报告强调了患者整个临床过程中面临的治疗和预后挑战,并试图强调认识到新药使用后SJS/TEN的发生并及时处理病情管理以改善患者长期预后的重要性。

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