摘要
1病例资料患者女,39岁,因“发热5天,躯干四肢皮疹伴疼痛4天”于2020年3月24日入北京大学第三医院皮肤科病房治疗。患者入院前18天开始因三叉神经痛服用卡马西平0.1 g,每日两次,甲钴胺0.5 mg,每日三次,入院前5天出现发热,体温最高达38.3℃,血常规提示血小板减少,外院考虑“上呼吸道感染”,并予口服头孢地尼0.1 g,每日三次;莲花清瘟颗粒6 g,每日三次;利可君20 mg,每日三次。入院前4天前胸和腹部出现红斑,并停用以上所有药物,后皮疹逐渐增多并扩散至四肢,部分红斑上出现米粒至黄豆大小水疱,口腔黏膜糜烂,双眼结膜充血,遂至北京大学第三医院皮肤科治疗。入院查体:体温36.3℃,脉搏90次/min,呼吸18次/min,血压130/85 mmHg,系统查体未见明显异常。
Stevens-Johnson syndrome is a type of severe drug eruption,which is characterized by rapid onset and rapid progress.If not treated in time,it can develop into toxic epidermal necrolysis,even life-threatening.Common sensitizing drugs include sulfa,carbamazepine,etc.In China,reports and studies of carbamazepine causing Stevens-Johnson syndrome mainly focus on the HLA-B*1502 gene,and there are no reports of HLA-A*3101 gene positive.We reported a patient who got Stevens-Johnson syndrome with HLA-A*3101 gene positive caused by carbamazepine.She took carbamazepine for trigeminal neuralgia and had never taken the drug before.After 2 weeks,papules and edematous target-like erythema gradually appeared on the trunk and limbs,surface blisters and scabs,and the oral,eyes,and vulvar mucosa appeared erosion,accompanied by fever and pain,with an area of about 3%exfoliation.She was diagnosed with Stevens-Johnson syndrome and admitted to Peking University Third Hospital on March 24,2020.After admission,in order to identify the sensitizing drugs,We performed a genetic test on her for carbamazepine-related drugs.The results showed that the HLA-A*3101 gene was positive,and the HLA-B*1502 and HLA-B*5801 genes were negative.In terms of treatment,the patient was systematically given a single intravenous infusion of 300 mg of infliximab,and symptomatic treatment and care of the oral,eye,and vulvar mucosa.After 6 days,the rash on the trunk and limbs subsided,and the mucosa returned to normal and was discharged from the hospital.Retrieving domestic and foreign literature,it is not uncommon to report that carbamazepine causes drug eruption,including severe drug eruption,and there are obvious ethnic differences in the pathogenicity of HLA genotyping.In China and Asia,stu-dies on carbamazepine causing Stevens-Johnson syndrome emphasized that the adverse reactions were strongly related to the HLA-B*1502 gene.However,there is a strong correlation with HLA-A*3101 gene in people suffering from the disease in Europe and Japan.In this case report,the HLA-B*1502 gene was negative and the HLA-A*3101 gene was positive.This is the first domestic report that carba-mazepine causes HLA-A*3101 positive for Stevens-Johnson syndrome.This report reminds that HLA-A*3101 gene testing should be taken seriously besides HLA-B*1502 gene.
作者
许媛媛
孙志琳
张秀莲
刘子莲
刘维
关欣
XU Yuan-yuan;SUN Zhi-lin;ZHANG Xiu-lian;LIU Zi-lian;LIU Wei;GUAN Xin(Department of Dermatology,Peking University Third Hospital,Beijing 100191,China;Department of Pharmacy,Peking University Third Hospital,Beijing 100191,China)
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2023年第4期755-757,共3页
Journal of Peking University:Health Sciences
