继发呼吸道烟曲霉菌感染的中毒性表皮坏死松解型药疹1例  

Drug-induced toxic epidermal necrolysis with secondary aspergillus fumigatus infection: a case report

作　　者：张思[1] 刘小扬 张建中[1] 蔡林[1] 周城[1] ZHANG Si;LIU Xiao-yang;ZHANG Jian-zhong;CAI Lin;ZHOU Cheng(Department of Dermatological,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院皮肤科

出　　处：《北京大学学报（医学版）》2019年第5期977-980,共4页Journal of Peking University:Health Sciences

摘　　要：大疱性表皮坏死松解型药疹属于重症药疹,死亡率为25%~40%,其致病药物以解热镇痛药、抗癫痫药、磺胺药及抗生素多见。临床上大疱性表皮坏死松解型药疹皮疹发展迅速,在数日内累及全身,引起弥漫性紫红色斑、水疱、大疱,皮肤糜烂渗出,伴有多处黏膜受损,常合并发热及内脏损害。对于本病的治疗,目前普遍认为及早给予足量糖皮质激素是治疗的关键,同时应加强支持治疗,纠正水电解质平衡,适当使用抗生素防治感染及加强皮肤、黏膜护理。本病的主要死因是感染及多脏器衰竭。Among the various drug induced dermatological entities toxic epidermalnecrolysis(TEN)and Stevens-Johnson syndrome(SJS)occupy a primary place in terms of mortality.Toxic epidermal necrolysis also known as Lyell’s syndrome was first described by Lyell in 1956.Drugs are by far the most common cause of toxic epidermal necrolysis,in which large sheets of skin are lost from the body surface making redundant the barrier function of the skin,with its resultant complications.Drug-induced toxic epidermal necrolysis are severe adverse cutaneous drug reactions to various precipitating agents that predominantly involve the skin and mucous membranes.Toxic epidermal necrolysis is rare but considered medical emergencies as they are potentially fatal.Drugs are the most common cause accounting for about 65%-80%of the cases.The most common offending agents are sulfonamides,NSAIDs,butazones and hydrantoins.An immune mechanism is implicated in the pathogenesis,but its nature is still unclear.There is a prodormal phase in which there is burning sensation all over the skin and conjunctivae,along with skin tenderness,fever,malaise and arthralgias.Early sites of cutaneous involvement are the presternal region of the trunk and the face,but also the palms and soles,rapidly spread to their maximum extent,the oral mucosa and conjunctiva being affected.Initial lesions are macular,followed by desquamateion,or may be from atypical targets with purpuriccenters that coalesce,from bullae,then slough.The earlier a causative agent is withdrawn the better is the prognosis.Several treatment modalities given in addition to supportive care are reported in the literature,such as systemicsteroids,high-dose intravenous immunoglobulins,ciclosporin,TNF antagonists.Recovery is slow over a period of 14-28 days and relapses are frequent.Mortality is 25%-50%and half the deaths occur due to secondary infection.Here we report a 50-year-old female of drug-induced toxic epidermal necrolysis.She was admitted to the dermatology ward with extensive peeling of skin ov

关 键 词：中毒性表皮坏死松解型药疹 烟曲霉菌 感染 呼吸衰竭 

分 类 号：R758.25[医药卫生—皮肤病学与性病学]