哌拉西林/他唑巴坦致急性嗜酸性粒细胞性肺炎1例及治疗思路分析

<正>伴嗜酸性粒细胞增多和系统症状的药疹(drug reaction with eosinophilia and systemic symptoms,DRESS),是一种危及生命的药物不良反应综合征,临床诊断困难且死亡率高。该病发病率在1/10 000～1/1 000^[1],可累及多个器官,急性嗜酸性粒细胞性肺炎(acute eosinophilic pneumonia,     

伴嗜酸性粒细胞增多和系统症状的药疹诊治进展

伴嗜酸性粒细胞增多和系统症状的药疹(DRESS)是一种危及生命的皮肤严重药物不良反应综合征,临床诊断困难且死亡率高.发病机制可能与特异性药物、免疫应答的改变、疱疹病毒再次激活以及HLA复合体的遗传易感性等多种因素相关.本文简要综述DRESS的诊治进展.     

嗜酸性粒细胞增多综合征35例临床分析并文献复习

嗜酸性粒细胞增多综合征是一组病因不明,血液及骨髓嗜酸性粒细胞持续增多,组织中嗜酸性粒细胞浸润为特征的一类疾病,本病少见。现将我院1990年10月至2011年8月诊治的35例嗜酸性粒细胞增多综合征患者病历资料报告如下。1临床资料     

万古霉素致儿童药物超敏反应综合征文献病例分析CSCD

目的了解万古霉素致儿童药物超敏反应综合征(DIHS)的临床特点。方法检索国内外数据库(截至2020年5月31日),收集万古霉素致儿童DIHS的病例报告类文献,提取患儿相关信息(性别、年龄、原发病、DIHS发生时间、主要症状、累及器官系统、血液学改变、RegiSCAR评分、治疗及转归等)进行描述性统计分析。结果共收集到万古霉素相关DIHS患儿12例,男性10例,女性2例;年龄22个月~17岁,中位年龄14岁。万古霉素暴露至出现DIHS的时间为5~35 d,中位时间为17 d。12例患儿的主要临床表现为发热(12例,100.0%)、皮疹(12例,100.0%)、淋巴结肿大(8例,66.7%)和黏膜损伤(5例,41.7%);合并肝损伤者9例(75.0%),肾损伤者4例(33.3%),肺损伤者2例(16.7%),脾损伤和心肌损伤者各1例(各8.3%)。11例(91.7%)患儿血常规检查显示嗜酸粒细胞增多,5例(41.7%)非典型淋巴细胞增多。诊断DIHS后12例患儿均停用万古霉素,经治疗(糖皮质激素、抗组胺药、丙种球蛋白等,1例行肝移植)后,11例患儿(91.7%)好转,1例(8.3%)死亡。结论万古霉素致儿童DIHS的临床表现典型,主要表现为发热、皮疹、淋巴结肿大等,受损器官主要是肝脏,其次为肾脏;多数预后较好,少数可出现严重器官功能损伤导致死亡。     

干扰素联合强的松龙治疗嗜酸性粒细胞增多综合征1例

嗜酸性粒细胞增多综合征是一组病因不明、血及骨髓嗜酸性粒细胞（EOS）持续增多、组织中EOS浸润为特征的一组疾病.在治疗方面皮质类固醇和免疫抑制剂治疗可获暂时临床缓解.本文报告利用α-干扰素联合强的松龙成功治疗嗜酸性粒细胞增多综合征1例.     

20例万古霉素致红人综合征国内文献分析

目的:探讨万古霉素致红人综合征的临床特点及相关因素,为临床用药提供参考。方法:对1994—2014年国内医药期刊报道的20例使用万古霉素致红人综合征的病例进行分类统计。结果:万古霉素所致红人综合征与性别无关,多发于儿童和50岁以上人群,考虑与肾功能存在可能相关性。在用药过程中和用药后均可发生,停药并对症处理多可治愈。万古霉素用药浓度过高可能是引起红人综合征的因素。结论:应加强对万古霉素使用的管理,了解红人综合征易发特点,加强监测,重点防治,减少其发生。     

特发性嗜酸性粒细胞增多综合征误诊1例分析

目的 了解儿童特发性嗜酸性粒细胞增多综合征诊断、鉴别诊断、治疗.方法 通过复习相关文献,了解本病的临床表现、诊断、鉴别诊断、治疗.结果 特发性嗜酸性粒细胞增多综合征诊断实际上是除外性的,最重要的是排除继发EOS增多的因素.结论 特发性嗜酸性粒细胞增多综合征临床表现多样,激素为首选的治疗药物.     

嗜酸性粒细胞增多症并发急性脑卒中1例

继发性嗜酸性粒细胞增多症较为罕见,寄生虫感染为其常见病因。嗜酸性粒细胞增多症常累及中枢神经系统,引起急性脑卒中,危及生命。在诊疗过程中,结合病史及临床资料,积极寻找脑卒中病因,注意继发性嗜酸性粒细胞增多症引发脑卒中的可能,及时诊断和治疗可以改善预后。本文通过回顾1例肝吸虫感染致嗜酸性粒细胞增多症患者的临床及影像学检查资料,探讨以急性脑卒中（分水岭梗死）为表现的继发性嗜酸性粒细胞增多症的影像学表现、发病机制、治疗及鉴别,旨在提高临床医师对继发于寄生虫感染的嗜酸性粒细胞增多症并发急性脑卒中的认识,为临床诊疗提供参考。     

嗜酸性粒细胞增多性皮炎16例分析

目的探讨嗜酸性粒细胞增多性皮炎的临床特点。方法回顾性分析嗜酸性粒细胞增多性皮炎患者的临床资料。结果 16例中男14例,女2例,平均年龄(51.3±13.3)岁,病程4~120个月,皮疹泛发、多形、剧痒,伴有一定的系统损害。糖皮质激素治疗有效,甘草制剂有一定疗效,部分患者治疗抵抗。结论嗜酸性粒细胞增多性皮炎患者多见于男性,甘草制剂有一定疗效。     

臭氧水疗联合系统用小剂量糖皮质激素治疗嗜酸性粒细胞增多性皮炎的疗效及安全性评价

<正>嗜酸性粒细胞增多性皮炎(HED)是嗜酸性粒细胞增多综合征(HES)病谱中的良性型,该病病程长,但无系统受累,临床表现为多形性皮损,外周血嗜酸性粒细胞增多及组织学中真皮致密的淋巴细胞、嗜酸性粒细胞浸润,并伴有剧烈瘙痒,严重影响患者的生活质量。系统应用中到大剂量糖皮质激素(泼尼松≥40mg)是该病的一线疗法~([1]),为了减少长期较大剂量应用糖皮质激素的副作用,我科采用臭氧水疗联合系统用小剂量糖皮质激素治疗HED取得了较好的疗效,现报告如下。     

The DRESS syndrome: the great clinical mimicker

The life-threatening DRESS (drug rash with eosinophilia and systemic symptoms) syndrome is characterized by the presence of at least three of the following findings: fever, exanthema, eosinophilia, atypical circulating lymphocytes, lymphadenopathy, and hepatitis. This syndrome is difficult to diagnose, as many of its clinical features mimic those found with other serious systemic disorders. This idiosyncratic reaction occurs most commonly after exposure to drugs such as allopurinol, sulfonamides, and aromatic anticonvulsants such as phenytoin, phenobarbital, and carbamazepine. We describe a 44-year-old woman who was brought to the emergency department with new-onset hemorrhagic stroke. She was admitted to the intensive care unit where she received supportive care that included clonidine and hydralazine for blood pressure control and phenytoin for seizure prophylaxis. On hospital day 21, the patient developed signs and symptoms of severe sepsis. Despite receipt of broad-spectrum antibiotics (vancomycin and piperacillin-tazobactam) and supportive care, the patient's clinical condition worsened with progressive jaundice, severe oliguria, and labile blood pressures. All cultures revealed no growth, and her chest radiograph remained clear. Several days after the onset of her fever, the patient developed several hematologic abnormalities including thrombocytopenia, with schistocytes present on a peripheral smear. She also had an elevated lactate dehydrogenase level. A provisional diagnosis of thrombotic thrombocytopenic purpura was made; however, the patient then developed severe facial edema, nearly global erythroderma, and severe exfoliative dermatitis. A punch biopsy of the skin was compatible with the DRESS syndrome. Phenytoin, vancomycin, and piperacillin-tazobactam were discontinued, and the patient was started on systemic corticosteroids, with rapid resolution of her fever and eosinophilia and progressive improvement in her skin rash and multiorgan system dysfunction. Use of the Naranjo adverse drug reaction probability scale indicated a probable relationship (score of 5) between the patient's development of DRESS syndrome and treatment with phenytoin. Clinicians should have a high index of suspicion for the DRESS syndrome in patients being treated with aromatic anticonvulsants who develop a sepsis-like syndrome. Furthermore, considering the potential severe effects associated with phenytoin, the risks and benefits should be carefully evaluated before using this agent for seizure prophylaxis.     

Risk factors associated with DRESS syndrome produced by aromatic and non-aromatic antipiletic drugs

Purpose  

DRESS (drug reaction with eosinophilia and systemic symptoms) is an idiosyncratic entity associated with the use of drugs. Its pathophysiology is not known, but is associated with immunological or genetic factors. The incidence is 0.4 cases per 1,000,000 general population. The syndrome usually develops at the beginning of treatment and is characterized by the presence of rash, fever, eosinophilia and systemic manifestations. The aim of our study was to describe the clinical manifestation and treatment of patients with DRESS associated with antiepileptic drugs (AEDs).     

Allopurinol-induced DRESS syndrome

A 70-year-old man was admitted to our clinic with complaints of fever, jaundice, dyspnea, and generalized rash after 3 months of allopurinol treatment for gout. On physical examination, he was found to have fever (38.5°C), jaundice, and generalized maculopapular rash. Leukocytosis, eosinophilia, elevation of liver enzymes, and hyperbilirubinemia were detected in his blood analysis. Skin biopsy was consistent with drug-induced hypersensitivity. He was diagnosed as Drug Rash with Eosinophilia and Systemic Symptoms (DRESS). Allopurinol treatment was stopped and steroid treatment was launched. At day 24 of admission, the patient died because of multiple organ failure.     

Nevirapine-induced rash with eosinophilia and systemic symptoms (DRESS)

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is an adverse reaction commonly occurring with antiepileptic agents. It was earlier referred to by various names such as dilantin hypersensitivity syndrome and anticonvulsant hypersensitivity syndrome. It is characterized by the triad of fever, skin eruption, and systemic involvement. DRESS syndrome has also been reported with a number of other drugs including allopurinol, minocycline, terbinafine, sulfonamides, azathioprine, dapsone, and antiretroviral agents such as abacavir and nevirapine. We describe a rare case of nevirapine-induced hypersensitivity syndrome that was successfully treated with oral steroids.KEY WORDS: Drug reaction with eosinophilia and systemic symptoms syndrome, drug rash, hypersensitivity, nevirapine     

Case reports: treatment of nevirapine-associated dress syndrome with intravenous immune globulin (IVIG)

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is an adverse drug reaction most commonly associated with aromatic antiepileptic agents. It is characterized by the triad of skin eruption, fever, and systemic involvement, with the latter usually manifesting as hepatitis and lymphadenopathy. Mortality is primarily due to hepatic failure and can be as high as 10%. Formerly referred to by names such as Dilantin hypersensitivity syndrome and anticonvulsant hypersensitivity syndrome, DRESS syndrome is a more precise term since this reaction pattern can be seen with other agents. DRESS syndrome has also been reported in association with sulfonamides, allopurinol, terbinafine, minocycline, azathioprine, and dapsone as well as with several antiretroviral agents such as abacavir and nevirapine. We describe a patient with HIV who developed nevirapine hypersensitivity syndrome who was successfully treated with intravenous immune globulin (IVIG).     

利伐沙班致皮疹文献病例分析

目的:探究利伐沙班导致皮疹的特点,为患者安全用药提供参考。方法:检索国内外数据库,获得利伐沙班致皮疹的病例报道文献,对病例的患者年龄、性别、既往病史,利伐沙班使用目的、使用剂量、联合用药,药品不良反应(ADR)出现时间、临床表现、处理、预后等信息,以及ADR关联性评价结果进行统计分析。结果:共检索获得16篇文献(16例患者)。ADR患者男女比例为1∶1,>60岁老年患者11例(68. 7%)。16例患者中14例的利伐沙班给药剂量符合药品说明书规定,12例患者联用了其他药物;5例(31. 3%)患者用药后第3天出现皮疹,3例(18. 8%)在用药10 d时出现。16例均出现全身多处散在红斑,其中8例明确诊断为伴嗜酸粒细胞增多及系统症状的药疹综合征、特发性血小板减少性紫癜、白细胞破碎性血管炎、血清病和神经性水肿;患者经治疗后症状改善。5例患者关联性评价为"很可能有关",11例为"可能有关"。结论:临床工作中要关注利伐沙班导致的皮疹,长期服药患者仍应引起重视。     

万古霉素相关血管炎文献病例分析

目的：分析万古霉素相关血管炎不良反应发生情况及其临床特点,为临床安全用药提供参考。方法：检索PubMed、Web of Science、Embase、EBSCO、Scopus、ScienceDirect数据库（检索时间为自建库至 2021 年4月）,收集万古霉素相关血管炎的病例报道并进行汇总分析。结果：共收集到万古霉素相关血管炎患者14例,其中男性10例（71.4%）,女性4例（28.6%）;所有患者中年龄最小的17岁,最大的83岁,中位年龄56.6岁。万古霉素暴露至发生血管炎的时间为1~27 d,多发生在7~15 d（9例）。14例患者均出现皮肤病变,表现为紫癜和（或）皮疹,其中累及四肢4例、下肢7例。13例进行了病变部位皮肤活检,12例示白细胞碎裂性血管炎,1例示狼疮样综合征。诊断血管炎后,14例患者均停用万古霉素,其中11例换用其他抗感染药物,4例接受糖皮质激素治疗,1例局部使用类固醇,14例患者均痊愈。结论：万古霉素相关血管炎多发生在用药后7~15 d,以男性患者居多,主要临床表现为紫癜和皮疹,多累及下肢,症状严重程度不同,及时停药均预后良好。     

心脏手术后抗感染治疗出现红人综合征的救治经验总结

目的:总结心脏手术后抗感染治疗导致红人综合征的救治经验。方法:回顾性收集南京大学医学院附属鼓楼医院2013年1月至2020年8月心脏手术后抗感染治疗出现红人综合征的病例资料,分析其临床特点及发生红人综合征的影响因素。结果:有6例患者在术后抗感染治疗中出现了严重的红人综合征,其中4例为应用万古霉素治疗过程中及治疗后出现红人综合征,1例使用替考拉宁23 d并停用5 d后出现,1例为应用头孢他啶治疗13 d后出现。6例患者经积极治疗后全部康复出院。结论:红人综合征在心脏手术后抗感染治疗过程中较为常见,多由万古霉素过敏引起。早期表现为局部出现红色皮疹、丘疹或斑丘疹,伴有瘙痒。如不积极治疗,皮疹可扩散至全身各部位,甚至出现休克症状,病情极为危重,早期高度重视并采取积极有效的抢救措施,可使患者转危为安。