莫西沙星片致 QT 间期延长和速发型变态反应

QT interval prolongation and type I hypersensitivity reaction caused by orally taken moxifloxacin

1例23岁女性患者因支原体肺炎合并急性化脓性扁桃体炎给予注射用美洛西林钠舒巴坦钠（2.5 g，1次/12 h）和阿奇霉素（0.5 g，1次/ d）静脉滴注，第11天因病情好转改为莫西沙星0.4 g口服，1次/ d。患者首次服用莫西沙星后约30 min 出现胸闷、心悸、气促、发热，接着出现颜面及全身潮红，四肢及躯干出现风团、红色丘疹伴瘙痒，心电图提示胸前导联 T 波双向、倒置，QT 间期延长，校正的 QT 间期为462 ms。实验室检查示肌酸激酶（CK）239 U/ L，CK 同工酶（CK-MB）35 U/ L。诊断为速发型过敏反应。停用莫西沙星并立即给予抗过敏治疗及对症处理，3 d 后皮肤症状消失，心电图正常，CK 40 U/ L，CK-MB 11 U/ L。

Mezlocillin sodium and sulbactam sodium for injection（2. 5 g,once every 12 hours）and azithromycin injection（0. 5 g,once daily）were given to a 23-year-old female patient due to the community-aquired mycoplasma pneumonia and acute purulent tonsillitis. On the eleventh day,the treatments above mentioned were changed to oral moxifloxacin 0. 4 g once daily because of the improvement of the patient＇s condition. Thirty minutes after the moxifloxacin administration for the first time,the patient felt chest tightness,palpitation,fever,and generalized flush accompanied by wheal and papula on her limbs and trunk. The electrocardiogram examination showed double directional or inverted T waves in the precordial leads and prolonged QT period with corrected QT interval 462 ms. Laboratory examination showed creatine kinase（CK）239 U/ L,isoenzyme of creatine kinase（CK-MB）35 U/ L. TypeⅠhypersensitivity reaction was diagnosed. Moxifloxacin was stopped and ananaphylaxis and supportive treatments were given immediately. Three days later,her skin symptoms disappeared,ECG examination result returned to normal. The levels of CK and CK-MB were 40 U/ L and 11 U/ L,respectively.