氟罗沙星致严重过敏反应一例

1 病历摘要 患者男,46岁,1个月前因受凉后出现发热,全身酸痛,体温40.6℃,伴头痛,无恶心、呕吐,在私人诊所进行输液治疗后,体温下降,头痛好转.     

氟罗沙星致严重过敏反应一例

1病历摘要 患者男,46岁,1个月前因受凉后出现发热,全身酸痛,体温40．6℃,伴头痛,无恶心、呕吐,在私人诊所进行输液治疗后,体温下降,头痛好转。10d前无诱因出现咳嗽、咯痰,痰呈白色黏液样,量少,易咯出,伴胸闷、气促、乏力、心悸,仍发热,多于夜问出现,体温37．0—38．5℃,就诊于外院,胸部X线片示右胸胸腔积液,予抽胸腔积液及治疗,症状无明显好转,遂转诊于我院,2008年10月21日门诊以“胸腔积液”收入我院治疗。患者入院时精神欠佳,饮食尚可,小便正常,大便3d未解。否认肝炎、结核、伤寒和高血压、糖尿病等病史,无手术、外伤及输血史,无食物、药物过敏史,预防接种史不详。     

氟罗沙星致严重过敏反应一例

1 病历摘要 患者男,46岁,1个月前因受凉后出现发热,全身酸痛,体温40.6℃,伴头痛,无恶心、呕吐,在私人诊所进行输液治疗后,体温下降,头痛好转.     

氟罗沙星致严重过敏反应一例

1 病历摘要 患者男,46岁,1个月前因受凉后出现发热,全身酸痛,体温40.6℃,伴头痛,无恶心、呕吐,在私人诊所进行输液治疗后,体温下降,头痛好转.     

氟罗沙星致严重过敏反应一例

1 病历摘要 患者男,46岁,1个月前因受凉后出现发热,全身酸痛,体温40.6℃,伴头痛,无恶心、呕吐,在私人诊所进行输液治疗后,体温下降,头痛好转.     

氟罗沙星致严重胃肠道不良反应1例

患者 ,女 ,36岁 ,2 0 0 3年 1月 8日 ,以“尿频、尿急、尿痛 ,伴血尿 2d ,小腹痛、腰酸”为主诉 ,入院。体检 :T 36 .7℃ ,P80次 /min ,R 19次 /min ,BP 12 0 / 10 0mmHg ;查尿常规 :Pro :+,BLD :+++,BIL(胆红素 ) :+,脓细胞 :++,红细胞 :++;血常规 :WBC 13.8× 10 9/L ,L 17.2 % ,N 77.1%。白带镜检显示 :脓球 :++,初步诊断为 :淋证 ,湿热下注 (中医诊断 ) ,急性泌尿系统感染 (西医诊断 )。给予“清热解毒 ,凉血通淋”之中药煎剂 (内含 :大小蓟 ,生地 ,丹皮 ,白茅根 ,仔草 ,车前子 ,淡竹叶 ,藕节 ,黑地榆 ,琥珀 ,甘草梢 ,茯苓等 ) …     

氟罗沙星静滴致谵妄

氟喹诺酮类抗菌药物由于其广谱、高效、无交叉耐药、价廉等特点在临床广泛应用.其神经系统毒性反应以失眠、头痛,头晕、烦燥多见.本文报道1例以失眠、头晕为主要特征的认知障碍患者,以加深临床医务工作者对此类药物不良反应的认识.     

氟罗沙星致异常出汗

患者男,36岁,体健.因外出饮食不当,出现腹痛、腹泻、呕吐等胃肠道症状来我院就诊,经急诊科医师检查,确诊为急性胃肠炎,即给予氟罗沙星注射液0.4g静滴,约10min后,发现患者开始出汗,但未引起注意,继续静滴10min后,患者出现异常出汗,汗水如流水般渗出皮肤,用纸巾擦拭很快被浸透,患者同时出现虚脱现象,但体温正常,BP 157.5/90mmHg.     

氟罗沙星致血尿1例

[病例]男,46 a.因胃出血入某院行胃切除术,出院后,来我院门诊换药.因伤口愈合不佳,见表皮红肿,给予氟罗沙星(华中医药集团驻马店地区制药厂,批号9909237)200 mg,po,qd,未用其他药物,14 h后出现尿中带血丝,未做任何检查及处理,停药2 d后,尿中血丝消失.     

Severe thrombocytopenia associated with once-daily rifampin therapy

Rifampin-induced thrombocytopenia has been recognized as an immunological reaction associated with intermittent high-dose therapy, and rarely seen with daily low-dose regimens. Our patient was a 33-year-old male with Marfan's syndrome who was given rifampin 600 mg/d po along with intravenous vancomycin for the treatment of Staphylococcus epidermidis endocarditis. His platelet count dropped from a baseline of 519,000/mm3 to 4000/mm3 after four doses of rifampin. Petechiae were present on the lower extremities without the presence of other bleeding sites. Rifampin, low-dose aspirin, and dipyridamole were discontinued. His platelet count returned to normal nine days after discontinuation of therapy. With the increasing use of rifampin for the treatment of nontuberculosis infections, clinicians should recognize the possibility of this drug causing such serious immunological reactions as thrombocytopenia, hemolytic anemia, acute renal failure, and shock with daily or intermittent therapy.     

辛伐他汀致严重过敏反应

患者女,53岁。因冠心病、不稳定型心绞痛、高血压病、高血脂症,于2002年3月22日入院。3月22日冠状动脉造影示:前降支近端75%偏心性狭窄,并有不稳定斑块影。左心室造影示:左室心尖部壁瘤。同时行病变血管直接支架置入术。术后患者心绞痛消失,72h心肌酶谱正常,手术成功。手术当日开始服用辛伐他汀片20mg·d-1,次日病人自觉轻微双下肢腓肠肌痛。检测肝、肾功能、血钾及心肌酶谱均正常,继续服辛伐他汀至第9天,患者从颜面到手足均出现充血性皮疹,皮疹为小米粒大小相互不融合的丘疹和伴痛痒的斑丘疹,相互融合成片。立即将患者收入院,停服辛伐他汀…     

Severe and resistant hypoglycemia associated with concomitant gatifloxacin and glyburide therapy

Severe and resistant hypoglycemia occurred in two patients with diabetes mellitus who were receiving concomitant gatifloxacin and glyburide. An 84-year-old woman treated with glyburide for type 2 diabetes mellitus experienced, for the first time, a severe episode of hypoglycemia after 2 days of gatifloxacin 400 mg/day for nonproductive cough. Her blood glucose level on hospital admission was 28 mg/dl. Gatifloxacin and glyburide were discontinued, and the patient was treated with intravenous dextrose infused over 36 hours. Glyburide was restarted before her discharge, with no recurrence of hypoglycemia. A 79-year-old man with type 2 diabetes mellitus treated with glyburide was prescribed gatifloxacin 400 mg/day for pneumonia. After 1 day of therapy, the patient was admitted to the emergency department in a coma. His blood glucose level was 18 mg/dl. Despite discontinuation of gatifloxacin and oral hypoglycemic therapy, hypoglycemia was reversed only after administration of multiple boluses of intravenous dextrose, followed by intravenous dextrose infused over 48 hours. On hospital day 7, gliclazide and levofloxacin were started; the patient experienced no recurrence of hypoglycemia and was discharged on day 10. Several cases of severe and resistant hypoglycemia associated with gatifloxacin therapy have been reported in the recent literature. Although the exact mechanism is not fully understood, it may be linked to a gatifloxacin-induced closing of the adenosine 5'-triphosphate-sensitive potassium channels in the pancreatic beta cells, leading to insulin secretion. The onset of hypoglycemia in relation to the start of gatifloxacin suggests that the drug precipitated this adverse event. Patients receiving oral hypoglycemic agents are at greater risk of experiencing gatifloxacin-induced hypoglycemia than patients not receiving these agents. Clinicians should be aware of this potentially life-threatening adverse event and monitor blood glucose levels in all patients receiving concomitant oral hypoglycemic agents and gatifloxacin.     

左氧氟沙星致严重过敏

患者女,53岁。欲于局麻下行踝关节螺丝钉取出术,于2003年6月25日上午10:30入急诊手术室。患者既往有风湿性关节炎病史,无心脏病、高血压等病史,亦无其他药物过敏史。手术前开放静脉,输注林格氏液。11:10为预防术后感染给予盐酸左氧氟沙星(易路美)0.2g溶于0.9%氯化钠注射液100ml中,慢速滴注。输入盐酸左氧氟沙星约10～20ml时,首先发现患者不能配合,继而全身抽搐,呼之不应,牙关紧闭,呼吸暂停,口唇紫绀。血气分析:pH7.24,PaCO245mmHg,PaO293mmHg,剩余碱分析(BE)11mmol·L-1,SpO275%,立即停药。给予面罩加压给氧,地西泮10mg静注,地塞米松1…     

头孢噻肟钠引起严重血小板减少

患者男,43岁。因交通事故扭伤腰部,于2004年3月8日入院。入院后经检查腰骶椎软组织严重损伤,疑有骨折。血压、心电图、血常规检查均正常。给予头孢噻肟钠1.0g,维生素C1.0g,酚磺乙胺0.5g,复方水溶性维生素(欣佳)粉针1瓶加入5%葡萄糖注射液250mL,静滴,1次/d。用药7d,血小板计数为70×109/L,其它血象指标均正常。用药10d后,血小板计数降至41×109/L,立即停止全部用药,经全面检查未见其它组织有出血情况。观察两周后,复查血小板略有回升。1个月后,抽骨髓作细胞形态学检查,结果显示:巨核细胞少,血小板少,粒、红两系轻度病态造血。此后1年,定期…     

二十五味松石丸引起严重肾功能损害

患者女,38岁。因患慢性乙型肝炎4年余,自1999年7月28日开始服用藏药二十五味松石丸,每日1丸(1g),至2002年7月停服,期间服用某藏医院的自制胶囊3种(成分不详),早、中、晚各服1种,每次1～3粒,至2003年1月18日。从2002年12月起,患者感到头晕、乏力、纳差,颜面及双下肢浮肿,活动后加重,偶有腰部酸痛感。2003年1月18日在某医院查外周血象:HGB60g·L-1,RBCl.98×1012·L-1,WBC5.7×109·L-1;尿蛋白(+),尿潜血(+)。2003年1月19日以“贫血待查”收住我院血液科。入院查体:T36.4℃,R20次·min-1,P80次·min-1,BP120/80mmHg(1mmHg=0.133kPa)。…     

别嘌醇致严重肝损害

1例83岁女性，因发现血尿酸升高服用别嘌醇100mg／d治疗。2周后出现恶心，乏力，黄疸。实验室检查示：AIJT945U／L，AST1521U／L，TBil259．3μmol／L，DBil137．8μmol／L。甲、乙、丙、戊型肝炎血清学检测为阴性，考虑肝损害与别嘌醇有关，停用别嘌醇，并给予复方甘草酸苷等治疗，1个月后症状逐渐改善，肝功能恢复正常。     

静脉滴注艾迪注射液致严重过敏性反应

患者男,42岁,有青霉素过敏史。因肺癌术后50余天,第2次化疗后1个月,于2005年5月8日10:15再入我院。CT示:右上肺叶后段及下叶背段占位并纵隔淋巴结转移,病理示:低分化鳞癌。术后曾给予顺铂(DDP)联合丝裂霉素(MMC)化疗2次。本次入院拟行化疗。入院检查:T36.2℃,P98次/min,R20次/min,BP120/90mm Hg(1mm Hg=0.133kPa),心腹(-),右肺呼吸音稍弱,叩诊音浊,未闻及湿罗音,浅表淋巴结不大。血常规:RBC3.85×1012/L,WBC8.15×109/L,Hb122g/L;肝功:ALT49U/L,AST41U/L,肾功能正常,二便(-),心电图示:窦性心律,心电轴轻度左偏。X线胸片:两肺…