拉莫三嗪%表皮坏死松解症,中毒性
拉莫三嗪%錶皮壞死鬆解癥,中毒性
랍막삼진%표피배사송해증,중독성
Lamotrigine%Epidermal necrolysis,toxic
1例7岁男性癫痫患儿服用丙戊酸(早0.25 g,晚0.5 g)2年后因病情加重加用拉莫三嗪,第1、2、3周用药剂量分别为12.5、25.0、37.5 mg/d.加药第15天患儿足部出现皮疹伴瘙痒、双眼发红,此后全身陆续出现红斑,颈部及四肢出现水疱,口腔黏膜糜烂,伴发热.加药第20天患儿入院,实验室检查示外周血白细胞计数7.6×109/L,红细胞计数3.9×1012/L,血红蛋白106 g/L,超敏C反应蛋白5.5 mg/L,白蛋白25.0 g/L,丙氨酸转氨酶(ALT) 66 U/L,天冬氨酸转氨酶(AST) 58 U/L.停用拉莫三嗪,给予抗炎、抗过敏、保肝及补液等对症治疗.入院第3天患儿出现高热、嗜睡、寒战,ALT 47 U/L,AST 33 U/L,乳酸脱氢酶(LDH) 207 U/L,肌酸激酶322 U/L,肌酸激酶同工酶(CK-MB)185 U/L,α-羟丁酸脱氢酶258 U/L.患儿躯体红斑上可见水疱,易破溃,颈、面部有大面积表皮脱落,呈红色糜烂面,伴渗出液,口腔糜烂面分泌大量黄色分泌物.诊断:中毒性表皮坏死松解症.予甲泼尼龙、复方甘草酸苷、丙种球蛋白、抗菌药物等综合治疗.入院第9天,患儿躯干、四肢水疱内液体大部分吸收,LDH 205 U/L,肌酸激酶247 U/L,CK-MB 31 U/L,ALT 28 U/L,AST 23 U/L.入院第13天,患儿生命体征平稳,全身散在斑点褪去.第15天出院.出院后1年随访,患儿皮肤未留瘢痕.
1例7歲男性癲癇患兒服用丙戊痠(早0.25 g,晚0.5 g)2年後因病情加重加用拉莫三嗪,第1、2、3週用藥劑量分彆為12.5、25.0、37.5 mg/d.加藥第15天患兒足部齣現皮疹伴瘙癢、雙眼髮紅,此後全身陸續齣現紅斑,頸部及四肢齣現水皰,口腔黏膜糜爛,伴髮熱.加藥第20天患兒入院,實驗室檢查示外週血白細胞計數7.6×109/L,紅細胞計數3.9×1012/L,血紅蛋白106 g/L,超敏C反應蛋白5.5 mg/L,白蛋白25.0 g/L,丙氨痠轉氨酶(ALT) 66 U/L,天鼕氨痠轉氨酶(AST) 58 U/L.停用拉莫三嗪,給予抗炎、抗過敏、保肝及補液等對癥治療.入院第3天患兒齣現高熱、嗜睡、寒戰,ALT 47 U/L,AST 33 U/L,乳痠脫氫酶(LDH) 207 U/L,肌痠激酶322 U/L,肌痠激酶同工酶(CK-MB)185 U/L,α-羥丁痠脫氫酶258 U/L.患兒軀體紅斑上可見水皰,易破潰,頸、麵部有大麵積錶皮脫落,呈紅色糜爛麵,伴滲齣液,口腔糜爛麵分泌大量黃色分泌物.診斷:中毒性錶皮壞死鬆解癥.予甲潑尼龍、複方甘草痠苷、丙種毬蛋白、抗菌藥物等綜閤治療.入院第9天,患兒軀榦、四肢水皰內液體大部分吸收,LDH 205 U/L,肌痠激酶247 U/L,CK-MB 31 U/L,ALT 28 U/L,AST 23 U/L.入院第13天,患兒生命體徵平穩,全身散在斑點褪去.第15天齣院.齣院後1年隨訪,患兒皮膚未留瘢痕.
1례7세남성전간환인복용병무산(조0.25 g,만0.5 g)2년후인병정가중가용랍막삼진,제1、2、3주용약제량분별위12.5、25.0、37.5 mg/d.가약제15천환인족부출현피진반소양、쌍안발홍,차후전신륙속출현홍반,경부급사지출현수포,구강점막미란,반발열.가약제20천환인입원,실험실검사시외주혈백세포계수7.6×109/L,홍세포계수3.9×1012/L,혈홍단백106 g/L,초민C반응단백5.5 mg/L,백단백25.0 g/L,병안산전안매(ALT) 66 U/L,천동안산전안매(AST) 58 U/L.정용랍막삼진,급여항염、항과민、보간급보액등대증치료.입원제3천환인출현고열、기수、한전,ALT 47 U/L,AST 33 U/L,유산탈경매(LDH) 207 U/L,기산격매322 U/L,기산격매동공매(CK-MB)185 U/L,α-간정산탈경매258 U/L.환인구체홍반상가견수포,역파궤,경、면부유대면적표피탈락,정홍색미란면,반삼출액,구강미란면분비대량황색분비물.진단:중독성표피배사송해증.여갑발니룡、복방감초산감、병충구단백、항균약물등종합치료.입원제9천,환인구간、사지수포내액체대부분흡수,LDH 205 U/L,기산격매247 U/L,CK-MB 31 U/L,ALT 28 U/L,AST 23 U/L.입원제13천,환인생명체정평은,전신산재반점퇴거.제15천출원.출원후1년수방,환인피부미류반흔.
A 7-year-old boy with epilepsy received sodium valproate (0.25 g in the morning and 0.5 g at night) for 2 years.Lamotrigine was added because of exacerbation of the illness.The dosage of lamotrigine on the first,second and third weeks were 12.5,25.0,and 37.5 mg once daily,respectively.On day 15 of taking lamotrigine,he developed erythema on foot,accompanied by pruritus and reddening of the eyes.After that the boy developed erythema on entire body,blister on neck,arms and legs,erosion of oral mucosa occurred accompanied by fever.The boy was hospitalized on day 20 of taking lamotrigine.Laboratory tests showed the following values:white blood cell count 7.6 × 109/L,red blood cell count 3.9 × 1012/L,hemoglobin 106 g/L,high-sensitivity C-reactive protein (hs-CRP) 5.5 mg/L,albumin 25 g/L,alanine aminotras nferase (ALT) 66 U/L,and aspartate aminotransferase (AST) 58 U/L.Lamotrigine was withdrawn,and the boy received the symptomatic treatments including anti-inflammation,anti-anaphylaxis,liver protection and fluid infusion.On day 3 of admission,the boy developed high fever,drowsiness and shiver.Laboratory tests showed the following values:ALT 47 U/L,AST 33 U/L,lactate dehydrogenase (LDH) 207 U/L,creatine kinase 322 U/L,creatine kinase isoenzyme (CK-MB) 185 U/L,and alphahydroxybutyric dehydrogenase 258 U/L.Meanwhile vesicles appeared on erythematous skin and ulcers occurred.A large area of exfoliation appeared on his neck and face.Ulcers were red with exudates.The purulent secretion was secreted from dental ulcer surface.He was diagnosed as toxic epidermal necrolysis.Then the boy received complex treatments included methylprednisolone,compound glycyrrhizin,gamma globulin,and antimicrobial drug.On day 9 of admission,most liquid in the blister on the trunk and limbs were absorbed.Laboratory test showed the following values:LDH 205 U/L,creatine kinase 247 U/L,CK-MB 31 U/L,ALT 28 U/L,and AST 23 U/L.On day 13 of admission,the boy's vital sign were stable,erythema on the body disappeared.On day 15,he was discharged.The result of follow-up one year later showed no scars on the boy's skin.
