多药联用致中毒性表皮坏死松解症1例分析

Toxic epidermal necrolysis caused by multi-drug combinations: a case report

目的探讨患者发生中毒性表皮坏死松解症的病因。方法梳理患者的诊疗经过,通过药物筛查、病原学检测和遗传学检测进行分析,探讨患者发生严重药品不良反应的原因。结果可疑药物包括头孢哌酮舒巴坦、洛哌丁胺、泮托拉唑,Narranjo评分无法区分可疑药物,ALDEN评分对3种可疑药物得的判断分别为"很可能""可能""可能"。基因检测显示患者未出现人类白细胞抗原等位基因突变;病原学检出细环病毒16型、细环病毒27型、人类疱疹病毒5型。结论患者可能在病毒感染与免疫力低下情况下因注射用头孢哌酮钠舒巴坦钠诱发了中毒性表皮坏死松解症。

Objective To investigate the etiology of toxic epidermal necrolysis. Methods The process of diagnosis and treatment of one case of toxic epidermal necrolysis was reviewed. The causes of serious drug adverse reactions were analyzed based on drug screening, pathogen detection and genetic detection. Results The drugs that might have caused toxic epidermal necrolysis included cefoperazone sulbactam sodium, loperamide and pantoprazole. The Narranjo score failed to distinguish suspicious drugs. The ALDEN score judged the three drugs as“probable”, “possible” and “possible”.Genetic test showed that the patient did not have any mutation of human leukocyte antigen alleles. The etiology of the patient’s blood detected the fine ring virus type 16, type 27 and human herpes virus type 5, which might have increased the susceptibility to the disease. Conclusion The toxic epidermal necrolysis of this patient might have been caused by cefoperazone sulbactam sodium along with viral infection and low immunity.