亚胺培南西司他丁钠致中毒性表皮坏死松解型药疹1例

One case of toxic epidermal necrolysis induced by imipenem and cilastatin sodium

1例48岁男性患者,因头颅外伤术后伴意识不清1个月入院。既往无药物、食物过敏史。急诊行开颅血肿清除术,术后患者出现发热,根据药敏试验结果给予头孢西丁。5 d后停用头孢西丁,改为亚胺培南西司他丁钠,3 d后患者出现红色皮疹,以胸背部为主,并逐步蔓延至全身,部分伴脱皮,皮肤科会诊后诊断为中毒性表皮坏死松解型药疹。遂停用亚胺培南西司他丁钠,改为头孢哌酮舒巴坦钠与磷霉素钠,并给予甲泼尼龙琥珀酸钠等抗过敏治疗,之后患者再无新发皮疹,皮损创面逐步干燥,面积也逐渐缩小。

One 48-year-old male patient with head trauma surgery was hospitalized because of unconsciousness for 1 month. The patient had no drug and food allergic history. After the evacuation of hematoma by craniotomy in emergency, the patient was fever, and the cefoxitin was used according to the susceptibility test. After 5 days, cefoxitin was discontinued, and the antibacterial agent was adjusted to imipenem and cilastatin sodium. Three days later, red rash appeared mainly in the patient＇s back and chest, and gradually spread to the whole body with peeling. Patient was diagnosed with toxic epidermal necrolysis. Then imipenem and cilastatin sodium was stopped, cefoperazone and sulbactam sodium and fosfomycin sodium were used for anti-infection, and methylprednisolone sodium succinate and other antiallergic treatments were given. Since then, no new rash appeared, skin wound gradually dried, and lesion area gradually diminished.