亚胺培南西司他丁钠与盐酸万古霉素联用致嗜酸粒细胞增多伴皮疹

Eosinophilia with skin rash induced by imipenem and cilastatin sodium combined with vancomycin hydrochloride

1例80岁女性患者因股骨髁间骨折切开复位内固定术后切口引流液培养检出阴沟肠杆菌，给予亚胺培南西司他丁钠0．5g，17欠／8h静脉滴注。第3天，嗜酸粒细胞计数由用药前的230×10^6／L升至520×10^6／L。第9天，嗜酸粒细胞计数为770×10^6／L。第11天，因切口引流液培养检出凝固酶阴性葡萄球菌，加用盐酸万古霉素1g，1次／12h静脉滴注。第18天，嗜酸粒细胞计数升至1810×10^6／L，停用亚胺培南西司他丁钠。第21天，患者出现双下肢皮疹伴瘙痒，给予抗过敏治疗。第26天，患者病情好转，嗜酸粒细胞计数仍高达2990×10^6／L，停用盐酸万古霉素。其后皮疹逐渐消退。第48天，嗜酸粒细胞计数降至20×10^6／L。

An 80-year-old female patient was given an IV infusion of imipenem and cilastatin sodium 0.5 g every 8 hours for Enterobacter cloacae detected in fluid drainage of incision after intereondylar fracture of femur open reduction and internal fixation. On day 3, the eosinophil count was increased from 230 × 106/L before using this medicine to 520× 106/L. On day 9, her eosinophil count was 770 ×106/L. On day 11, an IV infusion of vaneomycin hydrochloride 1 g every 12 hours was prescribed for eoagulase negative Staphylococcus detected in fluid drainage of incision. On day 18, the eosinophil count was 1810×106/L. Imipenem and cilastatin sodium was stopped. On day 21, the patient developed skin rash with pruritus on both lower extremities. She was given anti-allergic therapy. On day 26, her conditions improved, but the eosinophil count was still 2990 × 106/L. So vancomycin hydroehloride was stopped. The patient＇s rash gradually subsided. On day 48, the eosinophil count decreased to 20 × 106/L.