还原型谷胱甘肽致颌下腺肿大

Submaxillary gland enlargement caused by reduced glutathione

1例44岁男性患者因患慢性乙型肝炎和酒精性肝硬化合并肝性脑病2次住院治疗,住院期间均给予还原型谷胱甘肽和门冬氨酸鸟氨酸治疗,均在次日出现双侧颌下腺明显肿大。查体发现患者局部皮肤颜色和温度无异常,无明显压痛,口腔内黏膜完整,颌下腺导管口未见红肿。超声检查示双侧颌下腺弥漫性肿大,可探及周围淋巴结及双侧颈部淋巴结。首次发生颌下腺肿大时,未意识到与药物有关,未给予停药及特殊处理,患者颌下腺肿大于2 d后自行消退。第2次住院用药后患者又出现双侧颌下腺肿大,因患者既往多次住院均使用过门冬氨酸鸟氨酸,未出现颌下腺肿大,故考虑患者的颌下腺肿大与还原型谷胱甘肽有关。停用该药,继续门冬氨酸鸟氨酸治疗。1 d后患者颌下腺肿大完全消退。

A 44-year-old male patient was hospitalized twice for chronic hepatitis B and alcoholic cirrhosis with hepatic encephalopathy.During the 2 times of hospitalization,the patient was treated with reduced glutathione and ornithine aspartate and developed bilateral submandibular gland enlargement on the 2nd day after the first medication in each hospitalization.Physical examination showed no abnormal skin color and temperature,no obvious tenderness,intact oral mucosa,and no redness and swelling of submandibular gland duct orifice.Ultrasonic examination showed diffuse enlargement of bilateral submandibular gland and visible peripheral lymph nodes and bilateral cervical lymph nodes.It was never aware to be drug-related in the first occurrence of submandibular gland enlargement,therefore the drug was not stopped and no special treatment was given.The patient′s submandibular gland enlargement subsided spontaneously 2 days later.During the 2nd hospitalization,the patient developed bilateral submandibular gland enlargement again,which was considered to be related to reduced glutathione because no submandibular gland enlargement appeared in the patient during the repeated use of ornithine aspartate in the past.Then the reduced glutathione was stopped and ornithine aspartate was continued.The patient′s submandibular gland enlargement subsided completely 1 day later.