甲巯咪唑致大疱性表皮松解症

Methimazole-induced epidermolysis bullosa

1例52岁男性重型颅脑损伤患者因术后合并甲状腺功能亢进症给予甲巯咪唑（10 mg，2次/d）和普萘洛尔（10 mg，3次/d）鼻饲。第4天，患者颈部、躯干、双上肢前臂出现散在红色丘疹，甲巯咪唑剂量减半，并静脉滴注地塞米松（10 mg，2次/d），鼻饲氯雷他定（10 mg，1次/d）。第6天患者面部、颈部新发斑丘疹，部分融合成片，躯干、颈部可见水泡形成，伴高热；纤维支气管镜检查见气道充血、糜烂及血性痰液。停用甲巯咪唑，继续抗过敏治疗。第7天患者出现大面积表皮剥脱，诊断为大疱性表皮松解症，静脉滴注入免疫球蛋白（20 g，1次/d）和甲泼尼龙（60 mg，2次/d）。第12天，皮损创面渗液减少，停用人免疫球蛋白，甲泼尼龙予减量至40 mg，2次/d。1个月后，患者皮肤表皮基底呈鲜红色，有少量脓性分泌物，停用甲泼尼龙。6个月后，患者皮肤创面愈合，多处形成瘢痕。

A 52-year-old male patient with severe craniocerebral injury and hyperthyroidism was given nasal feeding methimazole 10 mg twice daily and propranolol 10 mg thrice daily. On day 4,the patient developed red papules which involve neck,body,and forearm. Methimazole＇s dosage was halved and he received an IV infusion of dexamethasone 10 mg twice daily and nasal feeding loratadine 10 mg once daily. On day 6,the patient developed maculopapular eruptions on the face and neck,some rashes fused into lamella,blisters emerged on the neck and trunk,accompanied by high fever. Bronchoscopy showed the airway congestion,erosion and bloody sputum. Methimazole was withdrawn and anti-anaphylactic treatment was continued. On day 7,a large area of exfoliation appeared. Methimazole-induced epidermal necrolysis was diagnosed. He received IV infusions of human immunoglobulin 20 g once daily and methylprednisolone 60 mg twice daily. On day 12,wound exudates were reduced. Human immunoglobulin was withdrawn and the dosage of methylprednisolone was changed to 40 mg twice daily. One month later,the body skin base was bright red and a small amount of purulent secretions appeared. Methylprednisolone was withdrawn. six months later,the surface of wound and scars healed.