特瑞普利单抗致Stevens-Johnson综合征

Stevens-Johnson syndrome induced by teriprizumab

1例56岁男性淋巴瘤患者接受特瑞普利单抗(240 mg静脉滴注、1次/3周)联合利妥昔单抗、吉西他滨和奥沙利铂抗肿瘤治疗。首次接受特瑞普利单抗治疗后第5天,患者全身出现皮疹,躯干和四肢出现大面积红斑,伴瘙痒和疼痛,全身>30%皮肤出现表皮剥脱;实验室检查示白细胞计数12.4×10^(9)/L,中性粒细胞计数11.5×10^(9)/L,红细胞沉降率162 mm/1 h,C反应蛋白74 mg/L,降钙素原1.09μg/L。患者以往曾接受过利妥昔单抗、吉西他滨和奥沙利铂抗肿瘤治疗,未出现皮肤反应,考虑可能为特瑞普利单抗引起的Stevens-Johnson综合征。立即予患者保护性隔离护理,并予以糖皮质激素、免疫球蛋白及抗感染等治疗。23 d后患者病情好转,破溃面积减少至10%;31 d后患者大部分破溃皮肤新生,实验室检查示红细胞沉降率46 mm/1 h,C反应蛋白15 mg/L,降钙素原0.04μg/L。

A 56-year-old male patient with lymphoma received anti-tumor treatments with treprizumab(intravenous infusion of 240 mg once every 21 days)combined with rituximab,gemcitabine,and oxaliplatin.On day 5 after the first treatment of treprizumab,the patient developed rash all over the body and a large area of erythema on the trunk and limbs,accompanied by pruritus and pain,and the exfoliation area of the whole body was more than 30%.Laboratory tests showed white blood cell count 12.4×10^(9)/L,neutrophil count 11.5×10^(9)/L,erythrocyte sedimentation rate 162 mm/1 h,C-reactive protein 74 mg/L,and procalcitonin 1.09μg/L.The patient had received antineoplastic therapy with rituximab,gemcitabine,and oxaliplatin and no skin reaction occurred.Stevens-Johnson syndrome induced by treprizumab was considered.Protective isolation care and symptomatic treatments such as glucocorticoid,immunoglobulin,and anti-infection were given.After 23 days of treatments,the patient was improved,and the skin ulceration area decreased to 10%.After 31 days of treatments,regenerated skin appeared under most of the ulcerated skin,and laboratory tests showed erythrocyte sedimentation rate 46 mm/1 h,C-reactive protein 15 mg/L,and procalcitonin 0.04μg/L.