大剂量地塞米松治疗过敏性紫癜致严重精神障碍1例

A Case of High-dose Dexamethasone Caused Severe Psychiatric Disorders for Treatment of Henoch-Schonlein Purpura

1例17岁女性患者因过敏性紫癜入院,初始精神无异常,地塞米松20 mg/d静脉输注5 d后逐渐出现情绪低落,莫名哭泣、睡眠障碍等症状,且逐渐加重。地塞米松使用2周后,患者出现躁狂、抑郁混合型精神障碍,遂予利妥昔单抗联合治疗,迅速停用地塞米松续贯泼尼松片口服。患者过敏性紫癜控制后出院转至精神专科医院,经抗精神病药物治疗,患者精神障碍在20 d内逐渐恢复至完全正常。本例精神障碍很可能与地塞米松有关,提醒临床应重视早期识别糖皮质激素导致的精神障碍,掌握正确处置该类不良反应的方法。

A 17-year-old female was treated with high-dose dexamethasone for henoch-schonlein purpura.At the beginning,there was no psychiatric disorders,however,after receiving dexamethasone(20 mg/d)intravenous infusion for 5 days,the patient gradually appeard depression,inexplicable crying,sleep disturbance and other symptoms,which gradually worsened.Two weeks later,the patient developed mixed psychiatric disorders with manic and depressive.In view of this situation,dexamethasone was quickly stopped,and then prednisone tablets were taken orally.The henoch-schonlein purpura of the patient was controlled and then was transferred to a psychiatric hospital,where the patient's psychiatric disorder gradually returned to normal within 20 days after treatment with antipsychotic drugs.In this case,the psychiatric disorders was probably related to dexamethasone.It was suggested that we should pay attention to early identification of mental disorders caused by glucocorticoids and master the correct disposal of such adverse reactions.