复方对乙酰氨基酚片（II）致大疱性表皮松解症和多系统损伤

Compound paracetamol tablets（II） caused epidermolysis bullosa and multisystem damage

1例48岁女性患者因受凉后全身疼痛自行口服复方对乙酰氨基酚片（II）3片,约4 h后躯干部出现皮疹伴瘙痒;4 d后全身皮肤出现肿胀及溃烂伴发热;5 d后口腔黏膜大面积糜烂,颜面部、躯干及四肢散在片状红斑和松弛性水疱,部分表皮剥脱,尼氏征阳性.实验室检查：WBC 8.1×10^9/L,中性粒细胞0.76,PLT 45×10^9/L,RBC 6.51×10^12/L,ALT 161 U/L,AST 155 U/L,蛋白总量45 g/L,白蛋白28 g/L,球蛋白17 g/L.诊断为大疱性表皮松解症,血小板减少症,药物性肝损伤.给予氯雷他定10 mg口服,1次/d;10%葡萄糖酸钙20 ml静脉注射,1次/d;地塞米松15 mg静脉滴注,1次/d.治疗第5天,患者皮损减轻,地塞米松减量至10 mg静脉滴注,1次/d,给予头孢他啶2.0 g静脉滴注,2次/d.治疗第8天,患者口腔黏膜糜烂消除,皮肤红肿渐消退,体温正常.实验室复查：PLT 225×10^9/L,ALT 92 U/L,AST 45 U/L.

A 48-year-old female patient took oral compound paracetamol tablets （II） 3 tablets for pain due to cold. She developed skin rash on her trunk accompanied by pruritus after 4 hours. Four days later, swelling, ulceration, and fever appeared on her whole body skin. The next day, she developed large area of the oral mucosal erosion, scattered erythema and flaccid blisters on her face, body, arms and legs, and partial exfoliation. The result of examination of Nikolsky＇s sign was positive. Laboratory test showed the following values： white blood cell 8.1×10^9/L, neutrophils 0.76, platelet count 45×10^9/L, red blood cell 6.51×10^12/L, alanine aminotransferase 161 U/L, aspartate aminotransferase 155 U/L, total protein 45 g/L, albumin 28 g/L, and globulin 17 g/L. The patient was diagnosed as epidermolysis bullosa, thrombocytopenia, and drug-induced liver injury. She was treated with oral loratadine 10 mg once daily, IV infusion of 10% calcium gluconate 20 ml, and dexamethasone 15 mg once daily. On day 5, the skin lesions relieved and dexamethasone was reduced to 10 mg once daily. An IV infusion of ceftazidime 2.0 g twice daily was given. On day 8, the oral mucosa erosion disappeared and skin rashes gradually subsided, the temperature declined to normal. The result of reexamination showed platelet count 225×10^9/L, alanine aminotransferase 92 U/L, aspartate aminotrans-ferase 45 U/L.