卡马西平超敏综合征

1例59岁男性患者因耳鸣服用卡马西平0.1 g,1～2次/d,服药7 d后出现双下肢一过性皮疹。停用卡马西平后皮疹消失,但随后耳鸣症状加重,遂入院,给予卡马西平0.1 g,2次/d口服;甲钴胺1 mg,3次/d口服。入院第2天患者体温39.2℃;第3天面颊部、躯干及双侧膝关节处出现红色斑丘疹。血生化检查示丙氨酸转氨酶359 U/L,天冬氨酸转氨酶137 U/L,γ-谷氨酰转移酶506 U/L,乳酸脱氢酶273 U/L。停用卡马西平及甲钴胺,给予甲泼尼龙及抗过敏治疗。2 d后体温恢复正常,5 d后皮疹、肝功能逐渐好转。入院第9天患者再度发热,体温38.1℃,随后皮疹再次出现,且逐渐增多,遍布全身。实验室检查:白细胞13.78×10~9/L,嗜酸粒细胞0.113;丙氨酸转氨酶187 U/L,天冬氨酸转氨酶45 U/L,γ-谷氨酰转移酶374 U/L,乳酸脱氢酶239 U/L。诊断为卡马西平所致药物超敏综合征,给予甲泼尼龙加用人免疫球蛋白治疗,皮疹症状及肝功能逐渐好转。入院第16天患者双下肢再次出现皮疹,经甲泼尼龙及对症治疗后缓解。

Carbamazepine-induced hypersensitivity syndrome

A 59-year-old man developed a temporary skin rash on his lower limbs after taking carbamazepine 0.1 g 1-2 times daily for seven days for tinnitus.His rash disappeared after withdrawal of carbamazepine.Subsequently,he was hospitalised with worsening tinnitus and received oral carbamazepine 0.1 g twice daily and oral mecobalamin 1 mg thrice daily.On day 2 of admission,his temperature was 39.2℃and,on day 3,he presented with a red maculopapular rash on his face,body,and both knees.Biochemical blood tests revealed the following values：ALT 359 U/L,AST 137 U/L,γ-GT 506 U/L,and LDH 273 U/L.Carbamazepine and mecobalamin was stopped.Methylprednisolone and anti-allergic therapy were given.Two day later,his temperature normalized and, five days later,rash and hepatic function improved gradually.On day 9 of admission,the patient had a fever again with a temperature of 38.1℃.Later,his rash recurred and progressed to involve his entire body.Laboratory tests showed the following levels：WBC 13.78×10~9/L with eosinophils 0.113,ALT 187 U/L,AST 45 U/L,γ-GT 374 U/L,and LDH 239 U/L.Carbamazepine-induced hypersensitivity syndrome was diagnosed.Methylprednisolone and human immune globulin were given and his rash and hepatic function improved.On day 16 of admission,the rash reappeared on his lower extremities,and then resolved after administration of methylprednisone and symptomatic treatment.