别嘌呤醇致药物超敏综合征三例报告并文献复习.pdfVIP

·76 · 临床误诊误治 ２０ 15 年 1 月 第 28 卷 第 1 期 Ｃｌｉｎｉｃａｌ Ｍｉｓｄｉａｇｎｏｓｉｓ ＆ Ｍｉｓｔｈｅｒａｐｙ熏 Ｖｏｌ．28熏 Ｎｏ．1熏 January ２０ 15 ·医源性疾病与医源性问题 · 别嘌呤醇致药物超敏综合征三例报告并文献复习 陈　 燕,朱晓雷,盛梅笑,赵建学 　 　 [摘要]　 目的　 探讨别嘌呤醇致药物超敏综合征(drugrashwitheosinophiliaandsystemicsymptoms,DRESS)的临 床特点及治疗方法。 方法　 回顾分析我院近年收治3例别嘌呤醇致DRESS 的临床资料。 结果　 本文3例因痛风或 高尿酸血症服用别嘌呤醇后1~2周左右出现全身弥漫性皮疹伴发热、肝肾功能损伤、血液学改变,2例出现少尿,1例 出现胆汁淤积性黄疸。 经相关医技检查及病因排查均诊断为别嘌呤醇过敏,DRESS。 3例均予糖皮质激素和(或)联 合丙种球蛋白治疗,2例病情缓解,但糖皮质激素减量过程中出现病情反复,1例死亡;另1例病情恶化放弃治疗。 结 论　 别嘌呤醇致DRESS临床表现多样,早期大剂量糖皮质激素治疗可有效控制症状,病情缓解后糖皮质激素减量应 缓慢,并警惕复发。 　 　 [关键词]　 别嘌呤醇;药物超敏综合征;药疹;药物毒性;误诊 [中国图书资料分类号]　 R971.1;R442.8　 　 [文献标志码]　 A　 　 [文章编号]　 1002-3429(2015)01-0076-04 [DOI]　 10.3969/ j.issn.1002-3429.2015.01.28 Drug Hypersensitivity Syndrome Caused by Allopurinol:A Report of 3 Cases and Literature Review a a a b CHEN Yan ,ZHU Xiao-lei ,SHENG Mei-xiao ,ZHAO Jian-xue ( Provincial Hospital of Traditional Chinese Medince of Jiangsu Province,a. Department of Nephrology,b. Department of Infectious Diseases,Nanjing210029,China) [Abstract]　 Objective　 To explore the clinical features and treatment of drug hypersensitivity syndrome (drug rash with eosinophilia and systemic symptoms,DRESS) caused by allopurinol. Methods　 Clinical data of3 patientswith DRESS caused by allopurinol admitted to our hospital in recent years were retrospectively analyzed. Results　 Three patients com- plained of fever,generalized rash,impaired renal and hepaticfunction and hematologic abnormalities after 1-2 weeks of allo- purinol treatment for gout or hyperuricemia. Twopatientsdevelopedoliguria,andtheother one developed cholestasisicterus. Three patientswere all diagnosed as having allopurinol allergy,DRESS,andwere all treatedwith glucocorticosteroid or com- binedwith intravenous immunoglobulin. Two patients had dramatic improvement in clinical condition,but relapsed as glu- cocorticosteroidtaperedoff. Oneof thepatientsdiedandonegaveupfurthert