别嘌醇过敏综合征并肾衰竭死亡

Allopurinol hypersensitivity syndrome with renal failure leading to death

1例68岁女性因高尿酸血症服用别嘌醇0.1g,3次/d治疗。治疗期间曾注射中药针剂3d。用别嘌醇51d后患者出现皮疹。给予氯雷他定和中药治疗后,症状加重。入院前3d,患者皮疹漫延全身并出现呼吸困难。入院后查体示:口唇黏膜溃烂,全身红色斑、丘疹、表面脱屑;实验室检查示BUN由7.10mmol/L升至34.19mmol/L,SCr由131μmol/L升至499μmol/L。诊断为别嘌醇过敏综合征。停用别嘌醇,给予地塞米松10mg,1次/d静脉滴注,患者最终死于肾衰竭和全身感染。

An 68-year-old woman was treated with allopurinol 0. 1 g thrice daily for hyperuricemia. She received traditional Chinese medicines （injection） for 3 days during allopurinol treatment period. After 51 days of allopurinol treatment, the patient developed rash. Loratadine and traditional Chinese medicines were given, but her symptoms worsened. Three days before hospitalization, the patient′s rash progressed to involve her entire body and dyspnea occurred. After admission, physical examination revealed ulceration of lips and oral mucous membrane, generalized red maculopapule, and superficial desquamation. Laboratory testing showed that BUN level increased from 7.10 mmol/L to 34. 19 mmol/L, and SCr level increased from 131 μmol/L to 499 μmol/L. Allopurinol hypersensitivity syndrome was diagnosed. Allopurinol was discontinued. An infusion of dexamethasone 10 mg once daily was given. Finally, the patient died from renal failure and concurrent generalized infection.