血浆置换治疗中毒性表皮坏死松解症1例

A case report of plasma exchange for toxic epidermal necrolysis

目的探讨中毒性表皮坏死松解症(TEN)病因、临床表现、预后和治疗方法。方法2016年8月山东大学齐鲁医院收治的1例41岁男性TEN病人,立即停用致敏药物,采用支持治疗和包括皮质激素、静脉注射免疫球蛋白、环孢素A、环磷酰胺、肿瘤坏死因子拮抗剂以及治疗性血浆置换等药物治疗。结果病人治愈出院,1年后随访,病人皮损部位恢复正常。结论TEN是一种严重的药物不良反应,其病理生理机制仍然不清楚,该病病情严重,病死率较高,提高对该病的早期诊断及鉴别诊断水平就显得尤为重要。TEN的治疗强调综合性治疗,对免疫反应的调节、对创面的护理、对全身状况的支持等都具有至关重要的作用。

Objective To explore the etiology,clinical manifestations,prognosis and treatment of toxic epidermal necrolysis(TEN).Methods In August 2016,A 41-year-old male patient with TEN admitted to Qilu hospital of shandong university immediately stopped using allergenic drugs and adopted supportive treatment including corticosteroids,intravenous immunoglobulin,cyclosporine A,cyclophosphamide,tumor necrosis factor antagonist and therapeutic plasma exchange.Results The patient was cured and discharged.After1 year of follow-up,the patient’s skin lesions returned to normal.Conclusion TEN is a serious adverse drug reaction,and its pathophysiological mechanism remains unclear.The disease is serious and the mortality rate is high.It is especially important to improve the early diagnosis and differential diagnosis of the disease.The treatment of TEN emphasizes comprehensive treatment,which plays a crucial role in the regulation of immune response,the care of wounds,and support for general condition.