尿激酶与低分子肝素钙联用致大疱性出血性皮肤病

Bullous haemorrhagic dermatosis induced by urokinase combined with low molecular weight heparin calcium

1例70岁女性患者因终末期肾病、肾性贫血、导管相关性感染,给予低分子肝素钙、左卡尼汀、重组人促红素、头孢他啶。因疑似导管局部细菌荚膜形成、长期留置导管堵塞,同时应用头孢他啶+尿激酶+低分子肝素钙泵入导管解除堵塞。用药第4天,患者出现全身轻度瘙痒,第5天左上肢及下腹部皮肤出现张力性血疱,暗红色,直径0.01~2 cm,形状近似半球状或不规则状,血疱边界清楚,触摸有轻微疼痛感;Nikolsky征阴性。诊断为大疱性出血性皮肤病(BHD),考虑由尿激酶与低分子肝素钙联用引起。当天停用2药,予无肝素血液透析。皮肤症状逐渐缓解,停药9 d后,血疱均干涸、结痂。2周后随访,全部血痂均已自行脱落。

A 70-year-old female patient was treated with low molecular weight heparin calcium,levocarnitine,recombinant human erythropoietin,and ceftazidime due to end-stage renal disease,renal anemia,catheter-related infection,etc.At the same time,ceftazidime,urokinase,and low molecular weight heparin calcium was pumped into the long-term indwelling catheter to dredge the catheter because of suspected local bacterial capsule formation and long-term indwelling catheter blockage.On the 4th day of treatments,the patient developed mild pruritus.On the 5th day,it was found that the skin of her left upper limb and lower abdomen was scattered with dark red blood blisters ranging from 0.01 to 2-cm,with approximate hemispherical or irregular shape,clear boundary,and slight pain in touch.Nikolsky sign was negative.Bullous haemorrhagic dermatosis was diagnosed and it was considered to be caused by the combination use of urokinase and low molecular weight heparin calcium.The 2 drugs were stopped and heparin-free hemodialysis was given.The skin symptoms were relieved gradually.After 9 days of drug withdrawal,the blood blisters dried up and scabbed.At a 2-week follow-up,all blood scabs fell off by themselves.