卡马西平致药物超敏综合征

Drug-induced hypersensitivity syndrome caused by carbamazepine

1例31岁男性患者因三叉神经痛服用卡马西平和甲钴胺2周。停药15d后,患者无明显诱因突然发热、咽痛、乏力,躯干出现弥漫性鲜红色斑丘疹,伴瘙痒,并进行性加重。实验室检查:白细胞计数13.1×10^9/L,中性粒细胞计数10.7×10^9/L,嗜酸细胞计数0.5×10^9/L,C反应蛋白807.5mg/L;丙氨酸转氨酶663U/L,天冬氨酸转氨酶332U/L。临床诊断为药物超敏综合征,给予甲泼尼龙、人免疫球蛋白、复方甘草酸苷、还原性谷胱甘肽等抗过敏和保肝治疗。19d后,患者症状好转出院。随访2周,患者血常规、肝功能恢复正常。经查阅药品说明书和文献报道,考虑该患者药物超敏综合征可能为卡马西平所致。

A 31-year-old male patient received carbamazepine and mecobalamin for 2 weeks due to trigeminal neuralgia. After 15 days of drug withdrawal, the patient developed fever, sore throat, fatigue, and diffuse bright red maculopapular rashes in the trunk, accompanied by itching, which progressively worsen. Laboratory tests showed white blood cell count 13.1×10^9/L, neutrophil count 10.7×10^9/L, eosinophil count 0.5×10^9/L, C-reactive protein 807.5 mg/L, alanine aminotransferase 663 U/L, and aspartate aminotransferase 332 U/L. Drug-induced hypersensitivity syndrome was diagnosed in the clinical. Anti-allergic and liver-protective drugs such as methylprednisolone, human immunoglobulin, compound glycyrrhizin, reduced glutathione, and etc. were given. Nineteen days later, the symptoms improved and the patient was discharged. At 2 weeks of follow-up, the patient showed normal blood routine test and liver function test results. According to the drug labels and the literature, it was considered that the drug-induced hypersensitivity syndrome was likely to be caused by carbamazepine.