非布司他致重症多形红斑型药疹

Severe erythema multiforme induced by febuxostat

1例49岁女性患者因慢性肾病合并高尿酸血症服用非布司他20 mg、1次/d, 用药第9天出现面部潮热, 随后头面部、躯干及双下肢逐渐出现紫红色斑丘疹, 皮疹逐渐加重并遍及全身, 累及眼睛、口腔及阴道黏膜, 腰部可见表皮松解性水疱, 表皮松解面积<10%。实验室检查示白细胞计数2.1×10^(9)/L, 中性粒细胞计数1.7×10^(9)/L, 血红蛋白59 g/L, 血小板计数97×10^(9)/L, C反应蛋白105.6 mg/L;血清肌酐1 062 μmol/L, 尿酸647 μmol/L, 人类白细胞抗原B*5801等位基因检测阳性。考虑可能为非布司他所致重症多形红斑型药疹。立即停用非布司他, 给予保护性隔离护理, 并予以甲泼尼龙、免疫球蛋白、血液透析联合血液灌流等治疗。治疗第16天, 患者唇黏膜可见黑色痂皮形成, 皮肤痂皮脱落30%。19 d后患者全身痂皮大部分脱落, 可见新生皮肤。实验室检查示白细胞计数和血小板计数恢复正常, C反应蛋白2.4 mg/L, 血清肌酐582 μmol/L, 尿酸424 μmol/L。

A 49-year-old female patient took febuxostat 20 mg once daily orally due to chronic kidney disease and hyperuricemia.On day 9 of medication,the patient developed facial hot flashes,and then purplish red maculopapules gradually appeared on the head,face,trunk,and both lower limbs.The rash were aggravated and spread gradually all over the body,involving the eyes,mouth,and vaginal mucosa.Lysis blisters appeared at the waist,and the area of epidermalysis was less than 10%.Laboratory tests showed white blood cell count 2.1×10^(9)/L,neutrophil count 1.7×10^(9)/L,hemoglobin 59 g/L,platelet count 97×10^(9)/L,C-reactive protein 105.6 mg/L;serum creatinine 1062μmol/L,and uric acid 647μmol/L;human leukocyte antigen B*5801 allele was positive.Severe erythema multiforme induced by febuxostat was considered.Febuxostat was stopped immediately and treatments including protective isolation care,methylprednisolone,immunoglobulin,hemodialysis combined with hemoperfusion were given.On day 16 of treatments,black scab was found on the lip mucosa,and 30%skin scab peeled off.After 19 days of treatments,most of the scabs of whole body fell off,and new skin was visible.Laboratory tests showed that white blood cell count and platelet count returned to normal,C-reactive protein was 2.41 mg/L,serum creatinine was 582μmol/L,and uric acid was 424μmol/L.