碘克沙醇注射液致重症多形红斑型药疹

Severe erythema multiforme caused by iodixanol injection

1例82岁男性冠状动脉粥样硬化性心脏病患者，注射碘克沙醇注射液约60ml行动脉造影术。术后第2天患者全身皮肤出现红色斑疹伴瘙痒，停用阿司匹林、比索洛尔、阿托伐他汀、氯吡格雷等所有药物，给予抗过敏治疗8d，症状逐渐加重，考虑为碘克沙醇引起的迟发型过敏反应。实验室检查示：白细胞计数10．1×10^9／L，中性粒细胞0．79，嗜酸粒细胞0．02，超敏C反应蛋白13．9μg／L，降钙素原0．189μg／L。诊断为重症多形红斑型药疹。给予甲泼尼龙琥珀酸钠、夫西地酸钠、利多卡因＋地塞米松加人碳酸氢钠溶液护理口腔、生理盐水＋庆大霉素＋地塞米松湿敷唇部等治疗后症状缓解。

An 82-year-old male patient with coronary atherosclerosis heart disease received iodixanol injection 60 ml for arteriography. On day 2 after operation, the patient developed erythema multiforme and itching. Aspirin, bisoprolol, atorvastatin, and clopidogrel were stopped and anti-allergy treatments were given. Eight days later, the symptoms worsened gradually. Delayed anaphylactic reaction induced by iodixanol was considered. Laboratory examination showed the following results： white blood cell count 10.1 x 10^9/L, neutrophils 0.79, eosinophils 0.02, high sensitivity C reaction protein 13.9μg/L, and procaleitonin 0. 189 μg/L. Severe erythema multiforme was diagnosed. The patient＇s symptoms improved after treatments with methylprednisolone sodium succinate, sodium fusidate, mouth care （lidocaine ＋ dexamethasone ＋ sodium bicarbonate solution）, wet dressin for lip （normal saline ＋ gentamicin ＋ dexamethasone）.