甲巯咪唑致药物超敏反应综合征1例及文献复习

Drug-Induced Hypersensitivity Syndrome Caused by Methimazole:A Case Report and Literature Review

目的提高对甲巯咪唑致药物超敏反应综合征(DIHS)的认识。方法分析医院救治的1例甲状腺功能亢进(简称甲亢)患者服用甲巯咪唑引起DIHS的临床表现和药物治疗方法,并复习相关文献。结果患者为17岁的女性,确诊甲亢,甲巯咪唑治疗1个月,出现全身红斑、丘疹,伴发热、外周血嗜酸性粒细胞水平升高、肝肾功能受损。确诊为DIHS,甲巯咪唑与DIHS关联性为"很可能",经验性给予糖皮质激素冲击和序贯治疗,抗过敏、抗感染治疗后痊愈。结论应警惕甲巯咪唑致DIHS的发生。使用甲巯咪唑后出现发热、皮疹、血液学异常、淋巴结肿大时,应怀疑是甲巯咪唑致DIHS,做到早发现、早治疗。

Objective To improve the understanding of drug-induced hypersensitivity syndrome(DIHS)caused by methimazole.Methods The clinical manifestations and drug treatment of DIHS caused by methimazole in a patient with hyperthyroidism treated in our hospital were analyzed,and the relevant literature was reviewed.Results A 17-year-old female patient with hyperthyroidism was treated with methimazole for one month.Then,she developed systemic erythema,papules,accompanied by fever,elevated levels of eosinophils in peripheral blood,and impaired liver and kidney functions.The patient was diagnosed as DIHS,which demonstrated that the association between methimazole and DIHS was very likely.She was empirically treated with glucocorticoid shock and sequential therapy and recovered after anti-allergy and anti-infection treatment.Conclusion We should pay attention to the occurrence of DIHS caused by methimazole.DIHS caused by methimazole should be suspected when fever,rash,hematological abnormality and lymphadenectasis occurred after treating with methimazole,so as to achieve early detection and early treatment.