阿昔洛韦致过敏性休克

Anaphylactic shock induced by acyclovir

1例34岁女性患者因带状疱疹自行涂抹3%阿昔洛韦软膏及自行静脉滴注阿昔洛韦0.25 g+0.9%氯化钠注射液100 ml。滴注约2 min后患者出现口唇麻木、胸部不适、头晕、乏力,立即停药,急诊入院,给予吸氧。旋即患者头面部、胸部及四肢近端皮肤出现红斑,口唇发绀、肿胀。停药约8 min患者出现视物不清,血压降至70/40 mm Hg(1 mm Hg=0.133 kPa)。约13 min出现黑曚、恶心、呕吐。经静脉注射地塞米松和肾上腺素、静脉滴注氢化可的松以及泵入多巴胺和去甲肾上腺素等处理,14 h后患者过敏症状完全消失。

A 34-year-old women self-medicated with 3% acyclovir ointment application and an IV infusion of acyclovir 0.25 g in 0.9% sodium chloride 100 ml for herpes zoster. About 2 minutes after the start of infusion, the patient developed lip numbness, chest distress, dizziness and asthenia. Acyclovir was stopped, and she presented to a hospital emergency department and was treated with oxygen inhalation. Soon afterwards, she developed the erythema on her skin of head and face, chest and proximal limb, as well as lip cyanosis and swelling. About 8 minutes after acyclovir infusion stopped, she had blurred vision, and her blood pressure decreased to 70/40 mm Hg. About 13 minutes later, she presented with amaurosis, nausea and vomiting. She was treated with IV dexamethasone, IV adrenaline, and an IV infusion of hydrocortisone, followed by dopamine and norepinephrine via a pump. After 14 hours, the allergic symptoms disappeared completely.