克林霉素引起的中毒性表皮坏死松解症合并消化道、泌尿道出血1例

Toxic epidermal necrolysis with gastrointestinal and urinary tract hemorrhage induced by clindamycin:1 case report

回顾性分析1例由克林霉素引起的中毒性表皮坏死松解症(TEN)合并消化道、泌尿道出血患者的病历资料。患者停用克林霉素;予静脉滴注甲泼尼龙、静脉注射人免疫球蛋白(IVIG)、磷霉素钠;予禁食、护胃,生长抑素、去甲肾上腺素、卡洛磺钠止血,碳酸氢钠碱化尿液;多次予血浆、人血白蛋白、脂肪乳氨基酸(17)葡萄糖(11%)注射液静脉滴注营养支持。经14 d治疗患者皮疹消退,消化道和泌尿道出血消失出院,随访3个月无异常。通过总结其发生的机制和治疗方案,说明克林霉素临床应用中有发生TEN的可能,TEN可能累及消化道、泌尿道黏膜致大量出血,药物亦可对内脏造成直接损害。早期识别、停用可疑药物和积极对症处理是治疗成功的关键因素。

The medical records of 1 patient with toxic epidermal necrolysis(TEN)with gastrointestinal and urinary tract hemorrhage induced by clindamycin were retrospectively analyzed.The patient was discontinued with clindamycin;intravenous methylprednisolone,intravenous immunoglobulin(IVIG),and sodium phosphomycin were given;fasting and gastric protection,growth inhibitors,norepinephrine,and sodium carnosulfate were given to stop bleeding,and sodium bicarbonate was given to alkalinize the urine;plasma,human albumin,and fatty milk amino acid(17)glucose(11%)injection were given intravenously several times for nutritional support.The patient was discharged after 14 d of treatment with resolution of the rash and disappearance of gastrointestinal and urinary tract hemorrhage,with no abnormalities at 3 months of follow-up.By summarizing the mechanism of its occurrence and treatment protocols,it is suggested that TEN may occur in the clinical application of clindamycin.TEN may involve gastrointestinal mucosa and urinary tract mucosa and cause massive bleeding.The drug may also cause direct damage to the viscera.Early recognition,discontinuation of suspected drugs and active symptomatic management are key factors for successful treatment.