环孢素致疼痛综合征1例及其相关文献分析

One case of pain syndromes caused by cyclosporine and literature review

1例特发性血小板减少性紫癜和系统性红斑狼疮的女性患者,入院后给予注射用甲泼尼龙琥珀酸钠、硫酸羟氯喹片及甲氨蝶呤片治疗,第17天将甲氨蝶呤更换为环孢素,第27天患者出现双膝关节隐痛,第36天患者诉全身多关节疼痛。第40天因患者手足癣加重,加用伊曲康唑抗真菌治疗。第41天患者诉全身骨痛,难以耐受,复查环孢素浓度显著升高,为404.5 ng·mL^-1,考虑伊曲康唑与环孢素相互作用所致,且患者骨痛不排除药品不良反应的可能,遂停用环孢素。第42天患者仍感疼痛剧烈,给予多种镇痛药效果不佳,遂停用伊曲康唑,第43天患者仍诉全身骨剧烈疼痛,同时因原发病恶化而放弃治疗。

A female patient with idiopathic thrombocytopenic purpura and systemic lupus erythematosus was treated with methylprednisolone sodium succinate for injection,hydroxychloroquine sulfate tablets and methotrexate tablets after admission.And methotrexate was replaced with cyclosporine on the 17th day.On the 27th day,the patient developed hidden pain of bilateral knee joints.On the 36th day,she complained of systemic polyarticular pain.Itraconazole was given to her on the 40th day because of the aggravation of tinea of feet and hands.On the next day,she developed intolerant systemic bone pain.The concentration of cyclosporine was obviously increased as high as 404.5 ng·mL^-1,which was considered as the result of the interaction between the itraconazole and cyclosporine.Moreover,the bone pain was also possibly associated with adverse drug reaction,so cyclosporine was stopped.On the 42nd day,she still complained of severe pain in spite of having various analgesics and then itraconazole was discontinued.On the 43rd day,the patient gave up treatment because of continuously severe pain and the aggravation of primary disease.