卡马西平致药物超敏反应综合征(附1例报告及文献复习)

Carbamazepine-induced Drug Hypersensitivity Syndrome:One Case Report and Literature Review

目的卡马西平易致皮疹,文中探讨卡马西平致药物超敏反应综合征及其可能机制。方法收集1例卡马西平致药物超敏反应综合征病例的临床资料,结合文献复习进行讨论。结果患者,68岁男性。因"单纯疱疹病毒性脑炎,继发性癫癎"规律服用卡马西平0.2 g,bid,抗癫癎治疗。服用后第28天,患者出现全身多发皮疹伴发热,3 d后至复旦大学附属中山医院就诊,立即停用卡马西平,予以甲泼尼龙静脉滴注,症状较前好转。后续独立加用左乙拉西坦、氯硝西泮治疗,皮疹再次加重,复查血常规示嗜酸性粒细胞3.10×10^9/L(14%),异型淋巴细胞12%。临床诊断为药物超敏反应综合征,遂停用所有抗癫癎药物,激素加量并辅以口服抗过敏药物和对症支持治疗,患者病情好转后出院。随诊1年,皮疹未再复发,且未再有癫癎发作。结论药物超敏反应综合征严重可致命,临床上需要紧急施以治疗,尽管左乙拉西坦、氯硝西泮所致皮疹的文献报道较少,且通常被认为在对芳香族类抗癫癎药物过敏患者的使用中是安全的,临床上替代治疗时需谨慎,小剂量起始、缓慢加量、密切监测。

Aim To analyze carbamazepine-induced drugs hypersensitivity syndrome and explore the possible mechanism.Methods The clinical data of a patient was collected and the related literature was reviewed and discussed.Results A case of 68-year-old man with secondary epilepsy after herpes simplex viral encephalitis who took carbamazepine 0.2 g twice daily was reported.Twenty-eight days after initiation,the patient developed widely-spread skin rashes and fever.He was admitted to our hospital three days later.The patient’s symptoms improved after discontinuation of carbamazepine and intravenous administration of corticosteroids.However,the situation deteriorated after addition of levetiracetam and clonazepam respectively.Reexamination of blood routine showed that eosinophils were 3.10×10~9/L(14%)and heterotypic lymphocytes were 12%.The clinical and laboratory findings were suggestive of druginduced hypersensitivity syndrome.In the end,the patient stopped taking any antiepileptic drugs.The dose of corticosteroids increased,oral anti-allergic drugs and supportive treatment were supplemented as well.The patient discharged from the hospital after improvement of condition.During one-year follow-up,there was no rash and seizure recurrence.Conclusion Severe drug-induced hypersensitivity syndrome can be fatal,which needs proper diagnosis and the emergent treatment.Although there are few reports on skin rashes caused by levetiracetam and clonazepam,and it is generally considered to be safe in patients who have had an allergic reaction to aromatic antiepileptic drugs,they should be used with caution,starting with a small dose,slowly increasing,and monitoring closely.