帕博利珠单抗治疗后应用阿莫西林致斑丘疹1例  

One case of maculopapule induced by amoxicillin after pembrolizumab treatment

作　　者：公静 陈晓琳 刘雪丽 杨珺 Jing GONG;Xiao-Lin CHEN;Xue-Li LIU;Jun YANG(Department of Pharmacy,Qingdao Central Hospital,Qingdao 266042,Shandong Province,China;Department of Pharmacy,National Cancer Center/National Cancer Clinical Medical Research Center/Cancer Hospital,and Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]青岛市中心医院药学部,山东青岛266042 [2]国家癌症中心/国家肿瘤临床医学中心/中国医学科学院北京协和医学院肿瘤医院药剂科,北京100021

出　　处：《药物流行病学杂志》2023年第1期95-98,共4页Chinese Journal of Pharmacoepidemiology

基　　金：山东省第一批药品临床综合评价项目(2021YZ014);青岛中医药科研计划项目(2020-zyy027)。

摘　　要：1例64岁男性右肺腺癌患者行化疗联合帕博利珠单抗治疗2周期后发生4级免疫介导肝损伤而住院治疗,期间服用阿莫西林胶囊0.5 g,q8h治疗肺部感染,用药约10 h后躯干部出现斑丘疹型药疹,未行处理。第2天早上皮疹遍布躯干部及双上肢,颜色加深。停用可疑药物阿莫西林胶囊,给予苯海拉明20 mg,im,盐酸西替利嗪10 mg,po,qd。第3天患者双上肢皮疹消失,躯干部皮疹部分消退,皮疹颜色变浅。第6天皮疹全部消失。患者既往多次服用阿莫西林,均未发生过敏反应,考虑本次出现阿莫西林致斑丘疹型药疹与帕博利珠单抗使用后引起的免疫状态过度激活有关。A 64-year-old male patient with right lung adenocarcinoma developed immune-mediated liver injury after treated with chemotherapy and pembrolizumab for 2cycles and was hospitalized.While in hospital,the patient took amoxicillin capsule 0.5 g once every 8 hours to treat lung infection.After about 10 hours of medication,the patient developed maculopapular drug eruption without treatment.In the 2nd morning,The rash spread to the trunk and upper limbs and the color darkened.Amoxicillin capsule were discontinued which was considered to be related to maculopapular drug eruption and diphenhydramine 20 mg intramuscularly and cetirizine hydrochloride 10 mg orally once daily was given.On the 3rd day,the rashes on both upper limbs disappeared,and the rashes on the trunk partly subsided,and the color faded.on the 6th day,the rashes disappeared totally.The patient taken amoxicillin many times in the past had not developed an allergic reaction.It was considered that the maculopapular drug eruption induced by amoxicillin in this case was related with activation of immune status after pembrolizumab.

关 键 词：帕博利珠单抗 阿莫西林 斑丘疹型药疹 免疫激活 

分 类 号：R969.3[医药卫生—药理学]