Sánchez I, García-Abujeta J L, Fernández L, Rodríguez F, Quiñones D, Duque S, López R, Jerez J
Allergy Section, Marqués de Valdecilla Hospital, Santander, Spain.
Allergol Immunopathol (Madr). 1998 Mar-Apr;26(2):55-7.
We present a case of a patient showing a cutaneous and systemic affectation compatible with the Stevens-Johnson syndrome due to the intake of tetrazepam as a muscular relaxant. The symptoms remitted after the suspension of the involved medicines and after treatment with systemic corticoids. Months later, a study with patch tests, with the standard battery and the medicines that she took (indapamide, tetrazepam, acetyl salicylic acid, botriozolam and levomepromazine) was carried out. She presented positivity to tetrazepam at 48 and 96 hours. The oral provocations with the other medicines, which she consumed, were negative. The study of cross reactivity with other benzodiazepines was negative. In the medical literature, different cutaneous affectations regarding benzodiazepine use (generalised drug eruptions, contact dermatitis, erythema multiforme, ...) have been described byt non Stevens-Johnson syndrome. The patch tests are useful in the diagnosis of this type of cutaneous reactions, avoiding in this way the achievement of oral provocations, with the potential risk for the patient that they imply. The absence of cross-reactions with other substances of the same group has to be pointed out, even with those with which keeps great structural similarity as the diazepam. In spite of the absence of cross reactions with the rest of benzodiazepines, faced with the seriousness of the case presented, it is advised to the patient to avoid this type of medicines.
我们报告一例患者，因服用作为肌肉松弛剂的四氮唑epam出现了与史蒂文斯-约翰逊综合征相符的皮肤和全身症状。停用相关药物并经全身用皮质类固醇治疗后症状缓解。数月后，对该患者进行了斑贴试验，采用标准系列及她所服用的药物（吲达帕胺、四氮唑epam、乙酰水杨酸、三唑仑和左美丙嗪）进行检测。她在48小时和96小时时对四氮唑epam呈阳性反应。对她所服用的其他药物进行口服激发试验结果为阴性。与其他苯二氮䓬类药物的交叉反应研究结果为阴性。在医学文献中，已描述了使用苯二氮䓬类药物引起的不同皮肤症状（全身性药疹、接触性皮炎、多形红斑等），但均非史蒂文斯-约翰逊综合征。斑贴试验有助于诊断此类皮肤反应，从而避免进行口服激发试验，因为口服激发试验对患者有潜在风险。必须指出，即使与结构高度相似的地西泮等同一类别的其他物质，也不存在交叉反应。尽管与其他苯二氮䓬类药物不存在交叉反应，但鉴于所呈现病例的严重性，建议该患者避免使用此类药物。
