丙戊酸钠致药物超敏反应综合征

Drug hypersensitivity syndrome induced by sodium valproate

1例20岁男性患者因手足徐动症服用丙戊酸钠缓释片500 mg、2次/d,20 d后全身出现弥漫性鲜红色斑块,压之褪色,皮温升高,面部肿胀,头颈部浅表淋巴结肿大,实验室检查示WBC 18.3＆#215;10 9/L,中性粒细胞0.392,淋巴细胞0.364,单核细胞 0.137,嗜酸粒细胞0.097,降钙素原0.3 μg/L,ALT 311 U/L,AST 148 U/L,ALP 295 U/L,γ-GT 169 U/L.考虑为丙戊酸钠所致药物超敏反应综合征.停用该药,给予糖皮质激素、抗组胺、保肝及局部外用药等对症支持治疗20 d后,患者全身红斑基本消退,55 d后患者皮疹全部消退,实验室检查示WBC 8.6＆#215;10 9/L,嗜酸粒细胞0.005,ALT 32 U/L,AST 22 U/L,ALP 66 U/L,γ-GT 67 U/L.

A 20-year-old male with athetosis received sodium valproate 500 mg twice daily.Twenty days after treatment, the patient developed general erythematous which faded after pressing, increased skin temperature, facial swelling, and enlargement of uperficial lymph node in his head and neck.Laboratory tests showed the following values： white blood cell （WBC） 18.3＆#215;10 9/L, neutrophils 0.392, lymphocytes 0.364, monocytes 0.137, eosinophils 0.097, procalcitonin （PCT） 0.3 μg/L, alanine aminotransferase （ALT） 311 U/L, aspartate aminotransferase （AST） 148 U/L, alkaline phosphatase （ALP） 295 U/L, gamma-glutamyl transferase （γ-GT） 169 U/L.The patient was diagnosed as drug induced hypersensitivity syndrome （DIHS）.Valproate was withdrawn.He received the symptomatic reatments which included glucocorticoid, antihistamines, liver protection and topical medication.Twenty days later, his erythematous rash were disappeared mainly.Fifty-five days later, his erythematous rash disappeared completely.Laboratory tests showed the following values： WBC 8.6＆#215;10 9/L, eosinophils 0.005, ALT 32 U/L, AST 22 U/L, ALP 66 U/L, γ-GT 67 U/L.