CAJ | 학술논문

报告单独使用肿瘤坏死因子α成功治愈别嘌醇导致伴嗜酸性粒细胞增多和系统症状的药疹(DRESS)的经过.男性痛风患者,60岁,发病前20 d口服别嘌醇,发热、全身皮疹伴有肝肾功能损害、白细胞和嗜酸性粒细胞升高、淋巴结肿大,合并糖尿病.经皮下注射益赛普25 mg(首剂加倍),隔天1次,共8次,获得痊愈.首次注射后,发热即控制；1d后皮损不再扩大,2d后皮损开始脱屑,5d后表皮新生；外周血肿瘤坏死因子α逐渐下降,治疗5周降至正常范围.入院后外周血白细胞、C反应蛋白、胆红素仍持续上升,在注射3次后开始下降,2周内逐渐恢复.转氨酶在首次注射后开始下降,2周内恢复.外周血嗜酸性粒细胞在首次注射后持续上升,于第10天达高峰,之后缓慢下降,治疗5周后降至正常范围.提示,肿瘤坏死因子拮抗剂能在疾病早期快速、安全、有效地控制伴嗜酸性粒细胞增多和系统症状的药疹,但不能阻止嗜酸性粒细胞上升.
보고단독사용종류배사인자α성공치유별표순도치반기산성립세포증다화계통증상적약진(DRESS)적경과.남성통풍환자,60세,발병전20 d구복별표순,발열、전신피진반유간신공능손해、백세포화기산성립세포승고、림파결종대,합병당뇨병.경피하주사익새보25 mg(수제가배),격천1차,공8차,획득전유.수차주사후,발열즉공제；1d후피손불재확대,2d후피손개시탈설,5d후표피신생；외주혈종류배사인자α축점하강,치료5주강지정상범위.입원후외주혈백세포、C반응단백、담홍소잉지속상승,재주사3차후개시하강,2주내축점회복.전안매재수차주사후개시하강,2주내회복.외주혈기산성립세포재수차주사후지속상승,우제10천체고봉,지후완만하강,치료5주후강지정상범위.제시,종류배사인자길항제능재질병조기쾌속、안전、유효지공제반기산성립세포증다화계통증상적약진,단불능조지기산성립세포상승.
A case of allopurinol-induced drug rash with eosinophilia and systemic symptoms successfully controlled by tumor necrosis factor-α (TNF-α) antagonist is reported.A 60-year-old man with gout and diabetes was admitted to the hospital for generalized pruritic eruptions with fever for four days.Twenty days prior to the presentation he was given oral allopurinol for the treatment of gout,and four days before the admission,he developed generalized exfoliative dermatitis complicated by fever,liver and kidney damage,leukocytosis,eosinophilia and lymph node enlargement.After the admission,he was treated with subcutaneous injection of recombinant human TNF-α receptor Ⅱ once every other day with the initial dose being 50 mg/d and maintenance dose 25 mg/d.The patient healed after eight sessions of injection.In detail,fever dropped and was controlled immediately after the first injection,epidermal detachment stopped within 24 hours,desquamation began two days later,and re-epithelization started five days later.The serum level of TNF-α descended gradually and reached the normal range on week 5 after the beginning of treatment.White blood cell count as well as Creactive protein and bilirubin levels in peripheral blood still continued to increase after the admission,began to decrease after three injections,and dropped gradually to the normal range within two weeks.Serum aminotransferase levels started to decrease after the fiint injection and returned to the normal range within two weeks.Peripheral eosinophil count continuously increased after the first injection,reached its peak on day 10,dropped gradually thereafter,and was restored to the normal range five weeks after the initiation of treatment.This case suggests that TNF-α antagonist used at early stage can control drug rash with eosinophilia and systemic symptoms rapidly,safely and effectively,but cannot prevent the increase of eosinophils.