伏立康唑致环孢素血药浓度升高相关癫痫样发作

1例18岁异基因外周造血干细胞移植术后女性患者服用环孢素100mg、1次/12h,吗替麦考酚酯1.0g、1次/12h,甲泼尼龙8mg、1次/12h,环孢素血药浓度维持在177～283ng/L。2个月后因肺部真菌感染加用伏立康唑200mg,1次/12h口服。用药第8天,患者出现头痛、头晕、视物模糊等症状,急诊入院。对症治疗无效且继续加重,出现牙关紧闭、四肢抽搐等癫痫样发作症状,急查环孢素血药浓度为378ng/L,考虑其癫痫样发作与环孢素血药浓度过高有关。停用环孢素和伏立康唑,对症治疗10d后症状好转,但肺部真菌感染未控制,重新给予伏立康唑200mg,1次/12h,将环孢素减量为75mg,1次/12h,血药浓度维持在250ng/L左右。入院治疗12d患者带药出院。随访1个月,上述症状未再出现。

Epileptiform seizure associated with elevated blood ciclosporin level caused by voriconazole

An 18-year-old woman received ciclosporin 100 mg 12-hourly,mycophenalate 200 mg 12-hourly,and methylprednisolone 8 mg 12-hourly following undergoing allergenic peripheral hematopoietic stem cell transplantation.The blood ciclosporin level was maintained at 177-283 ng/L.Two months later,oral voriconazole 200 mg 12-hourly was added to her regimen for treating pulmonary fungal infections.On day 8 of the drug therapy,the patient developed headache,dizziness,and blurred vision,he was then hospitalized with emergency.Symptomatic treatment was ineffective and her condition continued to worsen,and then symptoms of epileptiform seizure,such as trismus and convulsion of her limbs,occurred.Urgent testing revealed a blood ciclosporin level of 378 ng/L.Epileptiform seizure was considered to be related to elevated blood ciclosporin level.Ciclosporin and voriconazole were discontinued immediately.After 10 days of symptomatic and supportive treatment,the patient＇s condition improved gradually,but the pulmonary fungal infections were not controlled.Vorconazol 200 mg 12-hourly was given orally again,and the ciclosporin dose was decreased to 75 mg 12-hourly.Her blood ciclosporin was maintained at approximately 250 ng/L.After 12 days of treatment in hospital,the patient was discharged with her medicines.At 1-month follow-up,her above-mentioned symptoms did not recur.