索拉非尼联合信迪利单抗致中毒性表皮坏死松解症1例

A case of toxic epidermal necrolysis caused by sorafenib and sintilimab

1例67岁女性Ⅳ期右肾癌术后复发伴颅内多发转移癌患者使用索拉非尼联合信迪利单抗治疗,2周内患者出现发热、颜面部、背部、臀部及四肢红色花斑样皮疹;2 d后发热完全缓解,但双侧肘关节处、臀部及双侧大腿外侧皮肤出现皮下渗液,之后逐渐出现表皮松解脱落伴皮肤破溃;4 d后患者表皮松解面积> 30%体表面积,诊断为中毒性表皮坏死松解症(TEN)。采用ALDEN评分进行不良反应关联性评价,判断TEN“很可能”由索拉非尼和信迪利单抗共同诱导。停药治疗后患者TEN痊愈。本文探讨TEN与联合使用索拉非尼和信迪利单抗的相关性及处置措施,可为早期识别和正确治疗该疾病提供参考。

A 67-year-old female patient with postoperative recurrence of stage IV right renal cell carcinoma and multiple intracranial metastases was treated with sorafenib and sintilimab.Within 2 weeks,the patient had a fever and red spotted rash in facial,back,buttocks and limb.After 2 days,the fever completely relieved,but subcutaneous exudation appeared on the skin of both elbow joints,buttocks,and outer thighs,followed by gradual epidermal lysis and detachment with skin ulceration.After 4 days,the patient’s epidermolysis area was greater than 30%of the body surface area.The patient was diagnosed with toxic epidermal necrolysis(TEN).The adverse reaction correlation was assessed by ALDEN SCORE sheet.The adverse reaction of TEN was"likely"caused by sorafenib and sintilimab.After withdrawal and treatment,the TEN was cured.This paper explores the correlation between the TEN and the combination use of sorafenib and sintilimab and the management.This paper will provide reference for the early diagnosis and correct treatment of TEN.