阿奇霉素序贯依替米星引起剥脱性皮炎

Dermatitis exfoliativa due to azithromycin with etimicin sequentially

1例35岁急性脑梗死女性患者因合并肺炎给予阿奇霉素0.5g静脉滴注、1次/d,首次滴注结束后约10min,患者上肢、胸部及背部散发粟粒状红疹伴瘙痒。考虑为药疹,给予地塞米松10mg静脉注射、1次/d,氯雷他定片10mg口服、1次/d。次日抗感染用药改为硫酸依替米星0.3g入0.9%氯化钠注射液250ml静脉滴注、1次/d。第7天,患者皮疹消失、无瘙痒,停用地塞米松,改为泼尼松片30mg口服、1次/d,每3天减量10mg,于第14天停用,氯雷他定片继续使用。第15天,患者出现全身弥漫性红斑、面部及四肢水肿,再次给予地塞米松10mg静脉注射、1次/d。第17天,患者红斑消退、水肿减轻,面部、躯干及四肢出现脱屑,诊断为剥脱性皮炎,给予0.1%哈西奈德溶液混合郁美净润肤霜局部外用、3次/d。第19天,患者皮肤脱屑好转、水肿消退,地塞米松减至5mg、1次/d。第22天,患者皮肤少量脱屑,停用地塞米松,改为泼尼松片30mg口服、1次/d,每5天减量5mg。第26天,患者皮肤症状全部消失。随访1个月,患者皮疹无复发。

A 35-year-old female patient with acute cerebral infarction received an IV infusion of azithromycin 0.5 g once daily for combination with pneumonia.About 10 minutes after completing the first infusion,scattered red miliary rash with itching appeared on the patient's upper limbs,chest,and back.Drug eruption was considered,and dexamethasone 10 mg by an IV injection and loratadine tablets 10 mg by mouth once daily were given.On day 2 of admission,an IV infusion of etimicin sulfate 0.3 g,added into 0.9% sodium chloride injection 250 ml,was given once daily as anti-infective treatment.On day 7,with the disappearance of rash and itching,dexamethasone was replaced by prednisone tablets 30 mg orally once daily,and finally prednisone but not loratadine tablets were discontinued on day 14 through gradual reduction dose of 10 mg every 3 days.On day 15,the patient developed systemic diffuse erythema and facial and limb edema,and then an IV injection of dexamethasone 10 mg once daily was given again.On day 17,with the disappearance of erythema and reduction of edema,desquamation occurred on the patient's face,body and limbs,which was diagnosed as exfoliative dermatitis,and topical 0.1% halcinonide solution mixed with Yumeijing moisturizer was given externally thrice daily.On day 19,the patient's skin desquamation improved and edema subsided,and then the dose of dexamethasone was reduced to 5 mg once daily.On day 22,as the desquamation became slighter,dexamethasone was replaced by prednisone tablets 30 mg orally once daily,and the dose of prednisone was gradually reduced by 5 mg every 5 days.On day 26,all symptoms on the patient's skin disappeared.The rash did not recur at 1 month of follow-up.