信迪利单抗致重度药疹

Sever drug eruption induced by sintilimab

1例67岁男性患者因肝癌术后复发给予信迪利单抗(200 mg静脉滴注、1次/3周)免疫治疗,疗效及耐受性良好。用药12次后患者胸腹部及四肢散发皮疹,色鲜红,伴瘙痒。口服氯雷他定及外用卤米松乳膏后,患者皮疹稍好转。继续应用信迪利单抗2次,患者皮疹未见明显扩散。继续使用信迪利单抗第3次后,患者突发全身大面积皮疹,迅速发展为水疱、溃疡,皮肤有渗血及渗液,伴瘙痒和疼痛。诊断为药疹,考虑可能为信迪利单抗诱发。停用该药,给予甲泼尼龙60 mg静脉滴注、1次/d,并予抗过敏、抗感染、保护黏膜、皮肤护理等治疗1周,患者皮疹病情反复;增加甲泼尼龙剂量治疗1周,患者病情未缓解且出现消化道出血。患者肝癌术后,伴低蛋白血症、肝功能不全,且长期大剂量使用糖皮质激素,虽给予积极治疗措施,仍抢救无效死亡。

A 67⁃year⁃old male patient received immunotherapy with intravenous infusion of sintilimab 200 mg once every 3 weeks due to postoperative recurrence of liver cancer,and the efficacy and toler⁃ance was good.After 12 doses of sintilimab treatment,the patient developed a bright red skin rashes on the chest,abdomen,and extremities with itching.Oral loratadine and topical halometasone cream were given,and the rashes were improved slightly.The rashes did not spread in the next 2 doses of sintilimab treatment.But after the 3rd dose of continuing sintilimab,the patient suddenly developed a large⁃area rashes all over the body,which rapidly developed into blisters,ulcers,accompanied by oozing blood and fluid on the skin,itching,and pain.Drug eruptions were diagnosed,which was considered to be induced by sintilimab.The drug was stopped.After 1 week of treatments with intravenous infusion of methylprednisolone 60 mg once daily,anti⁃allergy,anti⁃infection,mucosal protection,and skin care,the rashes were repeated.Then the dose of methylprednisolone was increased,the rashes were still not relieved 1 week later,and gastrointesting bleeding occurred.After liver cancer surgery,the patient was accompanied by hypoproteinemia,liver dysfunction,and long⁃term high⁃dose glucocorticoid use.Therefore,despite active treatment measures,the patient still died of ineffective rescue.