拉莫三嗪与丙戊酸钠先后致皮疹、红细胞巨幼化及高敏综合征

Rash,megaloblastic and hypersensitivity syndrome caused by the use of lamotrigine and valproate

1例64岁男性患者,因癫痫反复发作口服丙戊酸钠(500 mg,bid)及拉莫三嗪(25 mg,qd)进行治疗,30 d后因发热、皮疹、抽搐、行走障碍入院。骨穿刺结果提示红细胞形态呈巨幼化,予氯雷他定(10 mg,qd,po)及复方甘草酸苷(60 mg,qd,ivgtt),停用拉莫三嗪,改用口服丙戊酸钠(早上750 mg,下午500 mg)抗癫痫,12 d后患者病情好转出院,继续服用丙戊酸钠抗癫痫。2 d后患者皮疹及发热再次加重入院,予甲泼尼龙(40 mg,bid,ivgtt)、氯雷他定(10 mg,qd,po)及复方甘草酸苷(60 mg,qd,ivgtt),停用丙戊酸钠改用苯巴比妥钠(100 mg,bid,im)抗癫痫治疗,20 d后改为苯巴比妥钠(30 mg,bid,po),期间患者发热及皮疹消退、肝功能恢复,于第22天出院。

A 64-year-old male patient was given valproate （500 mg, bid） and lamotrigine （25 mg, qd） for 30 days becauseof epileptic recurrent seizures. The patient was admitted to hospital for fever, rash, convulsions, walking disorders. Bone biopsytest indicated megaloblastic erythrocytes. Loratadine （10 mg, qd, po）, compound glycyrrhizin （60 mg, qd, ivgtt） were given andlamotrigine was stopped immediately. Valproate was administrated orally 750 mg in the morning and 500 mg in the afternoon to treatepilepsy. The condition of the patient improved after 12 days, and the patient took valproate when he was discharged from hospital.Two days later, the patient was admitted to hospital because of the aggravated rash and fever. Methylprednisolone （40 mg, bid, ivgtt）,loratadine （10 mg, qd, po） and compound glycyrrhizin （60 mg, qd, ivgtt） were given immediately, the valproate was stopped, and thephenobarbital （100 mg, bid, im） was given to treat epilepsy. After 20 days, phenobarbital injection was adjusted with oral dosage form（30 mg,bid,po）. The fever and rash disappeared, while the liver function of the patient recovered, finally the patient discharged onthe 22nd day.[KEY WORDS]