头孢羟氨苄片致药物超敏综合征并发急性心肌炎死亡  

Cefadroxil tablets induced-drug hypersensitivity syndrome complicated with acute myocarditis and death

作　　者：董淑杰[1] 曹轲[2] 翟所迪[1] Dong Shujie;Cao Ke;Zhai Suodi(Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China;Department of Cardiology, Peking University Third Hospital, Beijing 100191, China)

机构地区：[1]北京大学第三医院药剂科,100191 [2]北京大学第三医院心内科,100191

出　　处：《药物不良反应杂志》2019年第1期55-56,共2页Adverse Drug Reactions Journal

摘　　要：1例61岁女性患者因右眼睑裂伤缝合术后出现发热,自行口服头孢羟氨苄片0.5g、2次/d。服药后体温恢复正常,但未停药。用药2周后患者躯干四肢出现皮疹伴剧烈瘙痒,并出现发热(体温39℃),遂停药。但症状进行性加重,5d后出现面部肿胀,于发病第7天入院。入院时白细胞计数25×10^9/L,嗜酸粒细胞0.29,嗜酸粒细胞计数7.4×10^9/L,肝肾功能和心肌酶谱正常,心电图正常。给予抗过敏及对症治疗。入院第4天,患者出现头晕及全身乏力,血压96/61mmHg(1mmHg=0.133kPa),心率110次/min,心电图检查示多导联ST段抬高,超声心动图检查示少量心包积液,实验室检查示心肌肌钙蛋白T(cTnT)1.52μg/L、肌酸激酶(CK)236U/L、CK-MB63U/L、N末端脑钠肽前体(NT-proBNP)9708ng/L,诊断为药物超敏综合征并发急性心肌心包炎。给予大剂量甲泼尼龙(500mg/d)静脉滴注、人免疫球蛋白(40g/d)静脉滴注和营养心肌治疗。入院第5天,患者血压80/50mmHg,CK498U/L,CK-MB98U/L,cTnT5.33μg/L,左心室射血分数55%,转入心血管重症监护病房(CCU)。但患者病情进展迅速,转入CCU第3天,CK1252U/L,CK-MB231U/L,cTnT4.57μg/L,NT-proBNP17979ng/L,左心室射血分数10%;第6天左心室射血分数降至5%;第9天死亡。A 61-year-old female patient took cefadroxil tablets 0.5 g twice daily herself due to fever after blepharorrhaphy in her right eye. Her temperature returned to normal, but the medication was not discontinued and 2 weeks later, the patient developed skin rash on her limbs with severe itching, and fever (39 ℃). Then cefadroxil tablets were stopped but her symptoms were gradually aggravated, and then facial swelling appeared 5 days later. On the seventh day of onset, she was admitted to the hospital, with white blood cell count 25×10^9/L, percentage of eosinophils 0.29, eosinophil count 7.4×10^9/L, and normal liver and kidney function, myocardial enzymes, and electrocardiogram. Antiallergic and symptomatic treatments were given after the admission. On day 4 of admission, the patient developed dizziness and general fatigue. Her blood pressure was 96/61 mmHg and her heart rate was 110 beats per minute. The electrocardiogram showed multilead ST segment elevations and the echocardiography revealed a small amount of pericardial effusion. Laboratory tests showed that the cardiac troponin T (cTnT) was 1.52 μg/L, creatine kinase (CK) was 236 U/L, CK-MB was 63 U/L, and N-terminal pro-brain natriuretic peptide (NT-proBNP) was 9 708 ng/L. The patient was diagnosed with drug hypersensitivity syndrome complicated with acute myocarditis and pericarditis. Intravenous infusion of high dose methylprednisolone (500 mg/d), human immunoglobulin (40 g/d), and myocardial nutrition treatments were given. On day 5 of admission, the patient was transferred to the cardiovascular care unit (CCU), when her blood pressure was 80/50 mmHg, CK was 498 U/L, CK-MB was 98 U/L, cTnT was 5.33μg/L, and left ventricular ejection fraction was 55%. However, the patient′ myocarditis and pericarditis progressed rapidly. On day 3 in the CCU, the laboratory tests showed CK 1 252 U/L, CK-MB 231 U/L, cTnT 4.57 μg/L, NT-proBNP 17 979 ng/L, and left ventricular ejection fraction 10%, which then decreased to 5% on day 6. Finally, the patient died on day 9

关 键 词：孢羟氨苄 药物超敏综合征 心肌炎 死亡 

分 类 号：R969[医药卫生—药理学]