头孢地嗪钠致迟发性药疹伴肝损害

摘要1例74岁男性患者，因糖尿病、脑供血不足给予胰岛素、三七皂苷、奥拉西坦治疗。第3天因阻塞性肺炎加用头孢地嗪钠1．0g溶于0．9％氯化钠注射液100ml，2次／d静脉滴注。联合用药第5天，患者咳嗽、咯痰好转．但躯干及四肢皮肤出现皮疹，体温39．0℃。停用头孢地嗪钠、三七皂苷和奥拉西坦，并给予抗过敏和对症处理。停药后1d体温降至37．8℃，皮疹颜色较前变浅，但头面部出现新发皮疹。肝功能检查示天冬氨酸转氨酶（AST）596U／L、丙氨酸转氨酶（ALT）768U／L、血清总胆红素（TBil）39．1μmol／L。经过7d抗过敏、护肝治疗，患者全身皮疹基本消退，肝功能逐渐恢复正常（AST56U／L，ALT25U／L，TBil 12．5μmol／L）。其后未再使用头孢地嗪钠，而再次应用三七皂苷和奥拉西坦后未出现上述不良反应。

Cefodizime sodium-induced delayed drug eruption with liver damage

A 74-year-old male patient received insulin, arasaponin, and oxiracetam for diabetes mellitus and cerebral circulation insufficiency. On day 3 ,an IV infusion of cefodizirne sodium 1.0 g in 0.9% sodium chloride solution 100 ml twice daily was added to his regimen for pneumonia. On day 5 of combination therapy, his cough and expectoration improved while the patient experienced eruption on trunk and limbs with a high temperature of 39 ℃. Cefodizime sodium, arasaponin, and oxiracetam were all stopped and he was given anti-allergic and other symptomatic therapy. One day after drug discontinuation, his temperature decreased to 37.8 ℃ and the eruption was lighter in color than before. However, new eruption appeared on his head and face. Liver function examinations showed an aspartate aminotransferase （AST） level of 596 U/L, an alanine aminotransferase （ALT） level of 768 U/L, and a total bilirubin （TBil） level of 39.1 μmol/L. After receiving a 7-day anti-allergic and liver protective treatment, his generalized eruption vanished basically and liver function gradually return to normal （AST 56 U/L, ALT 25 U/L, and TBil 12.5 μmol/L）. Cefodizime sodium was not administered again and the above-mentioned adverse reactions did not recur after readministration of arasaponin and oxiracetam.