甲磺酸伊马替尼致重度水肿及剥脱性皮炎

1例54岁女性患者因"小肠间质瘤"术后肝转移,自行口服甲磺酸伊马替尼400 mg,1次/d,服用1个半月后出现心慌、全身重度水肿和皮疹,药物减量无缓解,遂入院。体格检查:心率78次/min,手脚皮肤皲裂伴液体渗出,睑结膜充血、水肿,全身重度水肿。实验室检查:嗜酸粒细胞0.74×109/L,红细胞计数3.44×1012/L,血糖6.67 mmol/L,丙氨酸转氨酶42 U/L。立即停药,给予氢氯噻嗪10 mg,3次/d口服;普罗帕酮100 mg,3次/d口服。患者心慌和水肿症状逐渐好转。入院第4天患者出现皮肤过度角质化、粗糙,局部脱屑;第7天出现全身大量皮肤脱屑,30 d后皮肤逐渐恢复正常。

Severe edema and exfoliative dermatitis caused by imatinib mesylate

A 54-year-old female self-administered imatinib mesylate 400 mg once daily for postoperative liver metastasis from small intestinal stromal tumor operation.After taking the drug for 45 days,the patient developed palpitation,severe systemic edema and rash.The symptoms did not improved after the dose reduction and then she was hospitalized.Physical examination revealed that her heart rate was 78 beats/min and chapped skin with fluid exudation occurred on her hands and feet.She also developed conjunctival congestion and edema,and severe systemic edema.Laboratory tests showed the following levels and values： eosinophil count 0.74×109/L,red blood cell count 3.44×1012/L,blood glucose 6.67 mmol/L,alanine aminotransferase 42 U/L.Imatinib mesylate was stopped immediately,hydrochlorothiazide 10 mg thrice daily and propafenone 100 mg thrice daily were given orally.The patient＇s palpitation and edema symptoms gradually improved.On day 4,the patient＇s skin developed hyperkereratosis,rough,and partial desquamation.On day 7,large areas of skin desquamation occurred.Thirty days later,her skin gradually returned to normal.