制霉菌素口腔黏膜给药致手足口病婴儿过敏性休克

Anaphylactic shock after applying nystatin to oral mucosa in an infant with hand-foot-mouth disease

1例7个月男婴因手足口病入院。住院后因并发霉菌性口炎,给予制霉菌素100万U溶于0.9%氯化钠注射液10 ml中涂于口腔黏膜局部,并静脉滴注痰热清注射液。之后,婴儿出现哭闹、四肢抽动,皮肤发绀及高热,BP 80/55 mm Hg,HR 160次/min。经抗过敏药物治疗后症状缓解。2 d后停用痰热清注射液,再次使用制霉菌素治疗,患儿再次出现紫绀、四肢厥冷,BP 70/50 mm Hg。停用制霉菌素,改为氟康唑治疗,上述症状未再发生。

A 7-month-old male infant was hospitalized with hand, foot and mouth disease. Nystatin one million units dissolved in 10 ml of 0.9% sodium chloride injection was applied to the oral mucosa of the infant for complication of mycotic stomatitis. Meanwhile, an Ⅳ infusion of Tanreqing injection was given. Subsequently, the infant presented with crying and noise, convulsion of extremities, skin cyanosis, and high fever; his BP was 80/55 mm Hg and his heart rate was 160 beats/min. His symptoms relieved after treatment with anti-allergic drugs. Two days later, Tanreqing injection was withdrawn and nystatin was continued. Cyanosis and peripheral coldness recurred; his BP was 70/50 mm Hg. Nystatin was stopped and changed to fluconazole. The above symptoms did not recur.