保泰松和泼尼松引起多脏器功能衰竭和急性造血功能停滞死亡

Death from multiple organ failure and acute aplastic crisis induced by phenylbutazone and prednisone

1名21岁女性患者因腰痛服用保泰松0.2g,3次/d;泼尼松10mg,3次/d。服药约26d后,出现发热、尿黄、水肿、皮疹。3d后停药,但症状继续加重。9d后入院,T38.7℃,P112次/min,皮肤巩膜重度黄染,实验室检查TBil190.9μmol/L,DBil132.2μmol/L,Alb29g/L,Glob31g/L,ALT251U/L,AST64U/L,ALP233U/L,γ-谷氨酰转移酶(γ-GT)251U/L,LDH594U/L,WBC13.5×109/L。腰椎MRI检查示腰3、4椎体结核。给予抗感染治疗、支持治疗、甲泼尼龙冲击治疗及血浆置换等,但患者黄疸逐渐加深,并出现腹胀,尿少,躯干、四肢出现暗红色小片状出血斑。肾功能检查示BUN15.5mmol/L,Cr189μmol/L。B超提示大量腹腔积液。血常规:WBC1.7×109/L,RBC2.04×1012/L,Hb58g/L,PLT19×109/L。骨髓检查显示为急性造血功能停滞。入院后第9天死亡。

A 21-year-old female with lumbar pain took phenylbutazone 0.2 g thrice daily and prednisone 10 mg thrice daily. About 26 days later, she developed a fever, dark urine, oedema, skin rash. Three days later, the drugs were stopped, but her symptoms continued aggravating. Nine days later, she was admitted. Her body temperature was 38.7 ℃ and pulse was 112 beats/min. She presented with severe yellowing of skin and sclera. Laboratory tests revealed the following values： TBil 190.9 μmol/L, DBil 132.2 μmol/L, Alb 29 g/L, Glob 31 g/L, ALT 251 U/L, AST 64 U/L, ALP 233 U/L, γ-GT 251 U/L, LDH 594 U/L, WBC 13.5×10^9/L. A lumbar MRI showed the 3rd and 4th lumbar vertebral body tuberculosis. The patient was given the anti-infective therapy, supportive therapy, methylprednisolone pulse therapy, and plasmapheresis. But her jaundice was aggravated gradually, and she developed abdominal distention, oliguresis, deep red-cloured tabular ecchymosis on trunk and limbs. Her levels of BUN and Cr were 15.5 mmol/L and 189 μmol/L, respectively, A B-scan ultrasound displayed a great quantity of seroperitoneum. A blood routine test revealed the values as follows： WBC 1.7×10^9/L, RBC 2.04×10^12/L, Hb 58 g/L, PLT 19×10^9/L. A bone marrow examination showed acute aplastic crisis. The patient died on day 9 after admission