别嘌呤醇致药物超敏综合征三例报告并文献复习

Drug Hypersensitivity Syndrome Caused by Allopurinol: A Report of 3 Cases and Literature Review

目的探讨别嘌呤醇致药物超敏综合征（drug rash with eosinophilia and systemic symptoms,DRESS）的临床特点及治疗方法。方法回顾分析我院近年收治3例别嘌呤醇致DRESS的临床资料。结果本文3例因痛风或高尿酸血症服用别嘌呤醇后1~2周左右出现全身弥漫性皮疹伴发热、肝肾功能损伤、血液学改变,2例出现少尿,1例出现胆汁淤积性黄疸。经相关医技检查及病因排查均诊断为别嘌呤醇过敏,DRESS。3例均予糖皮质激素和（或）联合丙种球蛋白治疗,2例病情缓解,但糖皮质激素减量过程中出现病情反复,1例死亡;另1例病情恶化放弃治疗。结论别嘌呤醇致DRESS临床表现多样,早期大剂量糖皮质激素治疗可有效控制症状,病情缓解后糖皮质激素减量应缓慢,并警惕复发。

Objective To explore the clinical features and treatment of drug hypersensitivity syndrome（drug rash with eosinophilia and systemic symptoms,DRESS） caused by allopurinol. Methods Clinical data of 3 patients with DRESS caused by allopurinol admitted to our hospital in recent years were retrospectively analyzed. Results Three patients complained of fever,generalized rash,impaired renal and hepatic function and hematologic abnormalities after 1-2 weeks of allopurinol treatment for gout or hyperuricemia. Two patients developed oliguria,and the other one developed cholestasis icterus.Three patients were all diagnosed as having allopurinol allergy,DRESS,and were all treated with glucocorticosteroid or combined with intravenous immunoglobulin. Two patients had dramatic improvement in clinical condition,but relapsed as glucocorticosteroid tapered off. One of the patients died and one gave up further therapy after his condition deteriorated. Conclusion The clinical presentation of drug hypersensitivity syndrome caused by allopurinol is diverse. High-dose glucocorticosteroid administered early can provide dramatic improvement in clinical condition,but relapse occurs when prednisone is tapered.So a slow taper off of glucocorticosteroid is required upon remission.