抗结核药引起血小板减少危象并紫癜

Thrombocytopenia crisis and purpura due to antitubercular agents

1例既往有肺结核病史的53岁男性患者因出现低热、多汗伴轻微干咳，在他院被诊断为“肺结核”，给予四联抗结核药物（异烟肼、利福平、吡嗪酰胺、乙胺丁醇）治疗。用药第11天，患者出现鼻出血和下肢瘀斑，瘀斑快速扩展至全身；第13天入我院，血常规检查示PLT 1×10^9/L，多层螺旋CT检查示右下肺感染（非肺结核性）。停用抗结核药物，予升血小板、抗过敏、止血、抗感染等治疗。治疗第4天，患者体温恢复正常，鼻出血停止，PLT 18×10^9/L；第7天，全身瘀斑消退，PLT 92×10^9/L；第16天，PLT 151×10^9/L，多层螺旋CT检查示右下肺病灶吸收。

A 53-year-old male patient who had a history of pulmonary tuberculosis with fever, hyperhidrosis with slight cough, in other hospital diagnosed as pulmonary tuberculosis, received quadruple anti tuberculosis therapy （isoniazid, rifampicin, pyrazinamide and ethambutol）. On the 11th day of therapy, patients developed nasal bleeding and lower extremity ecchymosis petechiae, rapidly expanding to the whole body. On the 13th day, the patient was sent to our hospital, the blood routine examination showed his blood platelet count（PLT）was 1×10^9/L, the antituberculous drugs were discontinued, and the treatment of raising platelets, anti allergy, hemostasis and anti infection was given. On the 4th day of treatment, the patient′s temperature returned to normal, the nasal bleeding stopped, and PLT was 18×10^9/L. On the 7th day, his body ecchymosis subside, and PLT was 92×10^9/L. On the 16th day, his PLT was 151×10^9/L, and multi-slice spiral CT examination showed right lower lung lesion was absorbed.