拉莫三嗪致中毒性表皮松解型药疹伴真菌性肺炎1例  

Lamotrigine Induced Toxic Epidermal Necrolysis Cases with Fungal Pneumonia

作　　者：王梦婷[1] 王红兵[1] 李谦[1] 吴莉[2] 黄云丽[1] 山林萍 李晓蓉[1] 李文双[1] 孙东杰[1] 

机构地区：[1]昆明医科大学第一附属医院皮肤科,云南昆明650002 [2]昆明医科大学第一附属医院影像科,云南昆明650002

出　　处：《中国医学文摘（皮肤科学）》2017年第3期293-296,共4页China Medical Abstracts(Dermatology)

摘　　要：患者男,24岁。全身红斑、丘疹、斑块伴痒痛3d。曾有卡马西平过敏史,因"病毒性脑炎"致"癫痫"8周,口服糖皮质激素及抗癫痫药(拉莫三嗪、丙戊酸钠及左乙拉西坦)3周后致高热伴全身充血性红斑、口唇糜烂3d,诊断为中毒性表皮松解性药疹。胸部CT示肺部感染。中后段痰液真菌培养、G试验及GM试验提示肺部曲霉感染,予糖皮质激素、抗生素、抗真菌药、丙种球蛋白联合治疗15d,皮损颜色变浅,无新发皮疹,无发热。后皮损再次增多,追问病史,患者家属私下自行加用拉莫三嗪2d,嘱其停用该药,经糖皮质激素及丙种球蛋白治疗后痊愈。A 24-year-old male patient was admitted to hospital for a total of seven days with erythema,papules,plaques and itching. There have been carbamazepine allergy,because of viral encephalitis caused by epilepsy 8 weeks,corticosteroids and oral antiepilepticdrugs（ sodium valproate and lamotrigine,levetiracetam） with systemic congestive erythema,erosion of lips causing high fever three days after 3 weeks,diagnosed as toxic epidermolysis of drug eruption,chest CT pulmonary infection in the posterior segment of the sputum fungal culture,G test and GM test indicated that the pulmonary Aspergillus infection,corticosteroids,antibiotics and antifungal drugs and immunoglobulin in the treatment of 15 days,skin color lighter,no new rash,no fever. After the lesions increased again,medical history,family members of patients with privately own lamotrigine 2 days,ask her to stop the drug,after glucocorticoid and gamma globulin treatment after recovery.

关 键 词：拉莫三嗪 中毒性表皮松解型药疹 癫痫 真菌性肺炎 

分 类 号：R758.25[医药卫生—皮肤病学与性病学] R563.1[医药卫生—临床医学]