左氧氟沙星致大疱性表皮松懈症型药疹并肾损害

Bullous epidermolysis type drug eruption and renal damage induced by levofloxacin

1例83岁女性患者因胆道感染给予左氧氟沙星注射液0.3g加入5%葡萄糖注射液250mL,1次/d静脉滴注。次日,患者T39.5℃,出现皮肤红斑、瘙痒,继而出现大水疱,部分破溃,主要见于胸腹部、臀部及会阴部;尼氏征(+)。实验室检查:WBC8.43×109/L,N0.74,β2-微球蛋白12.80mg/L,SCr458μmol/L,BUN16.0mmol/L,尿酸404μmol/L,尿蛋白(+)。诊断为大疱性表皮松懈型药疹合并肾损害。停用左氧氟沙星,改为头孢他啶1.0g,1次/d静脉滴注;甲泼尼龙80mg,2次/d静脉滴注;异丙嗪12.5mg肌内注射;泮托拉唑40mg静脉滴注;并外用甲紫及其他对症治疗。治疗7d后患者肾功能基本恢复,皮损好转但臀部破溃仍存在。约1个月后患者完全恢复。

A 83-year-old woman received an IV infusion of levofloxacin 0.3 g in 5% glucose 250 mL once daily for biliary tract infections.The next day,the patient developed skin erythema and itching,followed by blisters with ulcerations,mainly on her chest,abdomen,buttocks and genital area.Nikolsky sign was positive.Laboratory examination results were as follows：WBC 8.43×109/L,N 0.74,β2-microglobulin 12.80 mg/L,SCr 458 μmol/L,BUN 16.0 mmol/L,uric acid 404 μmol/L,and urine protein（＋）.She was diagnosed with toxic bullous epidermolysis type drug eruption with renal damage.Levofloxacin was discontinued immediately and replaced with an IV infusion of ceftazidine 1.0 g once daily,an IV infusion of methylprednisolone 80 mg twice daily,IM promethazine 12.5 mg and an IV infusion pantoprazole.In addition,external application of methyl violet and symptomatic treatment were given.Seven days after treatment initiation,her renal function partially recovered,and her skin lesions improved,but the ulceration on the buttocks remained unchanged.About one month later,she completely recovered.