阿达木单抗致重度特应性皮炎继发多重耐药菌感染  

Adalimumab-induced severe atopic dermatitis with secondary multidrug-resistant bacterial infection

作　　者：曲敬蓉 张雷[2] Qu Jingrong;Zhang Lei(Department of Clinical Pharmacy,Zhucheng People′s Hospital,Shandong Province,Zhucheng 262200,China;Department of Pharmacy,Yuhuangding Hospital,Shandong Province,Yantai 264000,China)

机构地区：[1]山东省诸城市人民医院临床药学科,诸城262200 [2]烟台毓璜顶医院药学部,烟台264000

出　　处：《药物不良反应杂志》2024年第9期571-573,共3页Adverse Drug Reactions Journal

摘　　要：1例15岁女性患儿诊断幼年特发性关节炎10年,2年前开始应用甲氨蝶呤联合阿达木单抗(80 mg皮下注射、1次/2周)治疗,用药1.5年后会阴、股部皮肤出现红色丘疹,伴瘙痒,皮疹逐渐累及头颈、四肢等全身多处,出现斑块、鳞屑,双小腿皮疹破溃渗出伴瘙痒和疼痛。根据皮肤病理结果、血清免疫球蛋白E增高,结合临床体征,考虑为阿达木单抗所致的重度特应性皮炎。患者皮肤创面分泌物培养结果提示金黄色葡萄球菌、铜绿假单胞菌、粪肠球菌耐药菌混合感染。停用阿达木单抗,给予抗过敏、敏感抗菌药物全身治疗和糖皮质激素局部治疗,14 d后皮疹和感染均好转。半年后随访,患者皮损基本痊愈。A 15-year-old female child with juvenile idiopathic arthritis for 10 years received methotrexate combined with adalimumab(80 mg by subcutaneous injection once every 2 weeks)2 years ago.After 1.5 years of treatments,red papules appeared on the skin of the perineum and thigh,accompanied by itching.The rash gradually spread to multiple parts of the body,including the head,neck,and limbs,with plaques and scales,and the rash on both calve ruptures and oozes,accompanied by itching and pain.It was considered to be severe atopic dermatitis caused by adalimumab based on skin pathological results,elevated serum immunoglobulin E,and clinical signs.The results of the patient′s wound secretion culture indicated a mixed infection of resistant bacteria such as Staphylococcus aureus,Pseudomonas aeruginosa,and Enterococcus faecalis.After discontinuing adalimumab and receiving systemic treatments with anti-allergic and sensitive antibiotics,as well as local treatment with glucocorticoids for 14 days,the rash and infection were improved.At the six-month of follow-up,the patient′s skin lesions were basically healed.

关 键 词：皮炎 特应性 阿达木单抗 肿瘤坏死因子抑制剂 药物相关副作用和不良反应 多重耐药菌感染 

分 类 号：R969.3[医药卫生—药理学]