糖尿病足恶性溃疡患者发生替考拉宁超敏反应综合征一例  

Teicoplanin-induced hypersensitivity syndrome in a diabetic foot patient with malignant ulcer

作　　者：邵佳鸣 王新刚[1] 余朝恒[1] 韩春茂[1] Shao Jiaming;Wang Xingang;Yu Chaoheng;Han Chunmao(Department of Burns and Wound Repair,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院烧伤与创面修复科,杭州310009

出　　处：《中华烧伤杂志》2020年第8期747-750,共4页Chinese Journal of Burns

摘　　要：2018年12月11日,浙江大学医学院附属第二医院收治1例58岁男性糖尿病足溃疡患者,予以局部扩创、负压封闭引流治疗及局部换药后,创面基本愈合出院。2019年1月15日,患者因创面局部感染破溃再次入院。再次入院后第3天行扩创手术,术后予以每天2次0.4 g替考拉宁静脉滴注治疗,术后组织病理检查提示角化型鳞状细胞癌。遂于再次入院后第10天行鳞状细胞癌扩大切除后自体刃厚皮移植及负压封闭引流治疗,术后患者出现全身发红伴皮疹,反复发热,体温高达39℃以上,伴白细胞计数及血小板计数降低。经多学科医师会诊后,考虑为替考拉宁超敏反应综合征,予以停用替考拉宁,改行激素治疗,患者体温转正常,血白细胞计数及血小板计数逐渐回升。患者于再次入院后第49天治愈出院。本病例提示使用替考拉宁治疗需要严格掌握用药指征,敢用敢停,早用早停,一旦治疗过程中发生上述异常情况,在排除感染和风湿免疫性疾病的情况下,应考虑到替考拉宁不良反应的可能。A 58-year-old male patient with diabetic foot ulcer was admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine on December 11,2018.The patient was treated with local debridement,vacuum sealing drainage treatment,and dressing change and discharged after basic wound healing.On January 15,2019,the patient was hospitalized again due to local infection and rupture of wound surface.He underwent a surgical debridement on the third day after second admission and was given intravenous infusion of 0.4 g teicoplanin twice daily.Histopathological examination after surgery showed keratinizing squamous-cell carcinoma.An extended squamous-cell carcinoma resection plus autologous split-thickness skin grafting and vacuum sealing drainage treatment was carried out on the 10th day after second admission.The patient′s whole body turned red after surgery with rash,recurrent fever over 39℃,leucopenia,and thrombocytopenia.A multi-disciplinary consultation of physicians attributed these symptoms to teicoplanin-induced hypersensitivity syndrome.After withdrawal of teicoplanin and administration of hormone,the patient′s temperature returned to normal,and the leucocyte count and platelet count recovered gradually.The patient was cured and discharged on the 49th day after second admission.The case presented reminds us of need to strictly follow the indications of teicoplanin prior to medication,be resolute to the administration and withdrawal,and be alert to adverse drug reactions when above-mentioned abnormalities occur,meanwhile,infection and rheumatic diseases are excluded.

关 键 词：糖尿病足 溃疡 癌 鳞状细胞 替考拉宁 药物超敏反应综合征 

分 类 号：R61[医药卫生—外科学] R622+.1[医药卫生—临床医学]