别嘌醇过量致超敏综合征合并肾功能不全急性加重死亡

1例49岁男性患者因痛风给予别嘌醇0.1 g，3次/d，但患者误服为0.3 g、3次/d，5 d后改为0.1 g、3次/d。服药25 d后患者出现发热伴皮肤瘙痒、斑丘疹。7 d后四肢、面部、腹部呈红皮病样改变，口腔可见溃疡，双侧扁桃体有大片白色渗出物，遂入院。实验室检查：白细胞计数14.1×10^9/L，嗜酸粒细胞计数1100×10^6/L；丙氨酸转氨酶130 U/L，天冬氨酸转氨酶93 U/L，总胆红素160.5μmol/L，直接胆红素144.3μmol/L；尿素氮39.2 mmol/L，肌酐628μmol/L，尿酸508μmol/L；凝血酶原活动度61%。诊断为别嘌醇致超敏综合征，药物性肝损伤，慢性肾功能不全急性加重。停用别嘌醇，静脉滴注复方甘草酸苷、谷胱甘肽、维生素C、维生素B6、亚胺培南西司他丁钠和人血白蛋白。入院第5天，患者出现高热、咳嗽、消化道出血，转入ICU，给予甲泼尼龙冲击治疗。随后2周，患者相继出现肺部感染、Ⅰ型呼吸衰竭、尿少和肾衰竭。入院第31天，患者因肝、肾衰竭和感染性休克死亡。

Death from hypersensitivity syndrome and acute exacerbation of renal insufficiency due to allopurinol overdose

A 49-year-old man suffered from gout and received treatment with allopurinol 0. 1 g thrice daily. He mistook the drug 0. 3 g thrice daily for 5 days and subsequent regimen was changed to 0. 1 g thrice＆amp;nbsp;daily. The patient developed fever,skin pruritus and maculopapules 25 days after drug administration. Seven days later,erythroderma appeared on his limbs,face and abdomen. He developed ulcers in mouth, and the bilateral tonsils were covered with large white exudate. Laboratory testing showed the following results：white blood cell count 14. 1 × 10^9/L,eosinophil count 1 100 × 10^6/L,alanine aminotransferase 130 U/L,aspartate aminotransferase 93 U/L,total bilirubin 160. 5 μmol/L,direct bilirubin 144. 3 μmol/L, blood urea nitrogen 39. 2 mmol/L,serum creatinine 628 μmol/L,uric acid 508 μmol/L,and prothrombin activity 61%. Allopurinol-induced hypersensitivity syndrome, drug induced liver injury and acute exacerbation of chronic renal insufficiency were diagnosed. Allopurinol was discontinued and he was given IV infusions of compound glycyrrhizin,glutathione,vitamin C,vitamin B6 ,imipenem and cilastatin sodium, and human albumin. On day 5 after administration,the patient developed fever,cough and gastrointestinal hemorrhage. Then he was transferred into intensive care unit and received methylprednisolone pulse therapy. The patient developed pulmonary infection,typeⅠrespiratory failure,reduced urine and kidney failure successively in the following two weeks. On day 31 of admission,the patient died from liver and renal failure and septic shock.