羟氯喹致系统性红斑狼疮患者高度房室传导阻滞

High-degree atrioventricular block secondary to hydroxychloroquine in a patient with systemic lupus erythematosus

1例67岁女性患者因系统性红斑狼疮（SLE）合并高血压病、颈动脉粥样硬化，口服给予羟氯喹片（100 mg、2次/d）、白芍总苷胶囊（0.6 g、3次/d）、吗替麦考酚酯分散片（0.5 g、2次/d）、硝苯地平缓释片（30 mg、1次/d）、辛伐他汀片（20 mg、1次/d）、阿司匹林肠溶片（100 mg、1次/d），以及注射用甲泼尼龙琥珀酸钠30 mg溶入0.9%氯化钠注射液100 ml静脉滴注、1次/d（6 d后改为口服泼尼松片30 mg、1次/d）。用药第13天患者突发晕厥，心电图检查示高度房室传导阻滞，考虑可能为羟氯喹所致，停用该药，其他药物继续应用。停用羟氯喹3 d后，患者房室传导阻滞消失。

A 67-year-old female patient with systemic lupus erythematosus （SLE） complicated with hypertension and carotid atherosclerosis received oral hydroxychloroquine tablets 100 mg twice daily, total glucosides of paeony capsules 0.6 g thrice daily, mycophenolate mofetil dispersible tablets 0.5 g twice daily, nifedipine sustained-release tablets 30 mg once daily, simvastatin tablets 20 mg once daily, and aspirin enteric tablets 100 mg once daily, and an IV infusion of sodium succinate for injection 30 mg dissolved in normal saline 100 ml once daily. Six days later, IV infusion of sodium succinate for injection was changed to oral prednisone tablets 30 mg once daily. On day 13 of medication, the patient suddenly developed syncope and electrocardiogram showed high-degree atrioventricular block. It was considered that hydroxychloroquine induced the high-degree atrioventricular block. Hydroxychloroquine was discontinued while the other drugs were continued. Three days after the drug withdrawal, atrioventricular block disappeared.