药物超敏反应综合征致暴发性1型糖尿病及桥本甲状腺炎一例及文献复习

Fulminant type 1 diabetes mellitus and Hashimoto＇s thyroiditis caused by drug-induced hypersensitivity syndrome： a case report and literature review

目的探讨药物超敏反应综合征（DIHS）导致暴发性1型糖尿病（FTlDM）及自身免疫性甲状腺病（AITD）的发病机制和临床特点，提高临床医师对DIHS后继发内分泌腺体受累的认识。方法对北京协和医院1例DIHS致FTlDM及桥本甲状腺炎的病例进行临床资料的收集和分析，并通过检索2000至2017年发表在PubMed的相关文献进行复习。结果本例患者DillS后出现皮疹、肝肾功能损害，之后相继出现FTlDM及桥本甲状腺炎。2000至2017年PubMed报道DIHS致1型糖尿病（T1DM）共26例，其中FTlDM共23例，经典T1DM共3例，大多在DIHS后2周至2个月之间发生；DIHS致AITD共11例，大多出现在DIHS后1至17个月。DIHS同时导致糖尿病和AITD共3例。结论DIHS可导致糖尿病、AITD，同一患者可出现多种内分泌腺体损害。DIHS后需长期随访，密切监测胰腺、甲状腺等内分泌腺体功能；此外，对有自身免疫病的患者需追溯DIHS病史。

Objective To explore clinical characteristics and pathogenesis of fulminant type 1 diabetes mellitus （FT1DM） and autoimmune thyroid disease （AITD） caused by drug-induced hypersensitivity syndrome （DIHS）. Methods Data of a case of FT1DM and Hashimoto＇s thyroiditis induced by DIHS was collected and analyzed. A systemic search was performed in PubMed for articles published between 2000 and 2017 and identified literatures were reviewed. Results The case was confirmed as DIHS with presentation of rashes, hepatic and renal damage, and followed by FF1DM and thyroids dysfunction. A total of 26 cases of DIHS induced T1DM were reported, including 23 cases of FT1DM and 3 cases of typical T1DM, which mostly occurred in 2 weeks to 2 months after DIHS. AITD induced by DIHS were found in 11 cases, with the onset in 1 to 17 months after DIHS. Conclusions Autoimmune endocrine disorders could be secondary to DIHS. Close monitoring of endocrine glands function after DIHS and tracing DIHS history before the onset of T1DM and AITD are necessary.