艾滋病合并中毒性表皮坏死松解症2例  

AIDS Complicated with Toxic Epidermal Necrolysis:Two Cases Report

作　　者：张维 李奇穗[1] 邓长刚 黄薇 孙艳雨 袁婧[1] ZHANG Wei;LI Qisui;DENG Changgang;HUANG Wei;SUN Yanyu;YUAN Jing(Infectious Disease Department,Chongqing Public Health Medical Center,Chongqing 400036,China)

机构地区：[1]重庆市公共卫生医疗救治中心感染科,重庆400036

出　　处：《中国皮肤性病学杂志》2022年第9期1063-1067,共5页The Chinese Journal of Dermatovenereology

基　　金：“十三五”国家科技重大专项(2018ZX10302104);重庆市科卫中医药技术创新与应用发展项目(2020ZY4094);重庆市医学科研指导项目(210-2-256)。

摘　　要：例1男,27岁,全身大疱性皮损伴破溃及少许渗液,并出现颜面肿胀4 d,意识障碍5 h。患者10年前确诊HIV抗体阳性,未接受抗HIV治疗。1周前患者因“癫痫”控制不佳,开始“丙戊酸钠片”抗癫痫治疗。结合实验室检查诊断:中毒性表皮坏死松解症、艾滋病等。停用“丙戊酸钠”,同时静注人免疫球蛋白(pH4)22.5 g/d[0.4 g/(kg·d)]共5 d治疗,氢化泼尼松40 mg 2次/d[1.5 g/(kg·d)]抗炎,予五水头孢唑林钠抗细菌,更昔洛韦抗疱疹病毒及对症治疗。例2男,45岁,全身多发大疱样皮损,部分皮肤破溃,伴大量渗液,部分伴有少量脓性分泌物,少量渗血,咽痛、咳嗽、咳少量白色黏痰、吞咽困难,发热,最高40.2℃。患者入院前3个月确诊HIV抗体阳性,CD4细胞21个/μL,HIV-1 RNA 5.23×10^(-5)CPs/mL,入院前1个月开始抗HIV治疗,方案:拉米夫定+富马酸替诺福韦+依非韦伦。血单纯疱疹病毒DNA、巨细胞病毒DNA阴性。床旁胸片:双下肺散在片状影,考虑感染可能。主要诊断:中毒性表皮坏死松解症、全身皮肤细菌感染、细菌性肺炎、艾滋病。停用全部抗HIV药物,静注人免疫球蛋白(pH4)20 g/d[0.4 g/(kg·d)]冲击治疗共5 d,氢化泼尼松50 mg 2次/d[2 g/(kg·d)]抗炎,并予美罗培南1 g每8 h 1次抗细菌等对症治疗。A 27-year-old male patient presented with systemic bullous lesions with ulceration and a little exudation,facial swelling for 4 d,and disturbance of consciousness for 5 h.The patient was diagnosed as HIV-positive 10 years ago and did not receive anti-HIV therapy.One week before admission,the patient received“sodium valproate tablet”antiepileptic treatment because of poor control of“epilepsy”.Combined with the results of laboratory tests,the diagnosis was toxic epidermal necrolysis and AIDS.“Sodium valproate”was withdrawn.Meanwhile,human immunoglobulin(pH4)22.5 g/d[0.4 g/(kg·d)]was injected intravenously for 5 d,and prednisone 40 mg twice a day[1.5 g/(kg·d)]was given as anti-inflammatory,cefazolin sodium pentahydrate as anti-bacterial,and ganciclovir as anti-herpesvirus and symptomatic treatment.A 45-year-old male presented with multiple bullous lesions all over the body,some skin ulceration accompanied by a large amount of exudation,some accompanied by a small amount of purulent secretions,a small amount of blood seepage,sore throat,cough,a small amount of white phlegm,dysphagia,fever,and the highest temperature of 40.2℃.The patient was confirmed positive for HIV antibody at 3 months before admission,with 21 CD4 cells/μL and 5.23×10^(5)copies of HIV-1 RNA/mL.Anti-HIV therapy was initiated at one month before admission,with the regimen of lamivudine,tenofovir fumarate and efavirenz.Auxiliary examination revealed negative for herpes simplex virus DNA and CMV DNA.Bedside chest X-ray revealed that scattered images of both lower lungs,considering the possibility of infection.Diagnosis of toxic epidermal necrolysis,systemic skin bacterial infection,bacterial pneumonia,and AIDS was made.All anti-HIV drugs were stopped and human immunoglobulin(pH4)was injected intravenously at 20 g/d[0.4 g/(kg·d)]for 5 d,hydroprednisone 50 mg twice a day[2 g/(kg·d)]for anti-inflammatory,and meropenem 1 g per 8 h for anti-bacterial treatment.

关 键 词：艾滋病 中毒性表皮坏死松解症 文献复习 

分 类 号：R512.91[医药卫生—内科学] R758.25[医药卫生—临床医学]