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1例59岁男性患者因耳鸣服用卡马西平0.1 g,1～2次/d,服药7 d后出现双下肢一过性皮疹。停用卡马西平后皮疹消失,但随后耳鸣症状加重,遂入院,给予卡马西平0.1 g,2次/d口服;甲钴胺1 mg,3次/d口服。入院第2天患者体温39.2℃;第3天面颊部、躯干及双侧膝关节处出现红色斑丘疹。血生化检查示丙氨酸转氨酶359 U/L,天冬氨酸转氨酶137 U/L,γ-谷氨酰转移酶506 U/L,乳酸脱氢酶273 U/L。停用卡马西平及甲钴胺,给予甲泼尼龙及抗过敏治疗。2 d后体温恢复正常,5 d后皮疹、肝功能逐渐好转。入院第9天患者再度发热,体温38.1℃,随后皮疹再次出现,且逐渐增多,遍布全身。实验室检查:白细胞13.78×10~9/L,嗜酸粒细胞0.113;丙氨酸转氨酶187 U/L,天冬氨酸转氨酶45 U/L,γ-谷氨酰转移酶374 U/L,乳酸脱氢酶239 U/L。诊断为卡马西平所致药物超敏综合征,给予甲泼尼龙加用人免疫球蛋白治疗,皮疹症状及肝功能逐渐好转。入院第16天患者双下肢再次出现皮疹,经甲泼尼龙及对症治疗后缓解。
A 59-year-old man with carbamazepine 0.1 g, 1 or 2 times / day was given tinnitus. A double skin rash occurred after 7 days of treatment. Carnitine flattened the rash disappeared, but then tinnitus symptoms aggravated, then hospitalized, given carbamazepine 0.1 g, 2 times / d orally; methylcobalamin 1 mg, 3 times / d orally. On the second day after admission, the temperature of the patient was 39.2 ℃. On the third day, the red rash appeared on the cheeks, trunk and bilateral knees. Blood biochemical tests showed alanine aminotransferase 359 U / L, aspartate aminotransferase 137 U / L, γ-glutamyl transferase 506 U / L, lactate dehydrogenase 273 U / L. Disable carbamazepine and mecobalamin, given methylprednisolone and anti-allergy treatment. After 2 days, the body temperature returned to normal. After 5 days, the rash and liver function gradually improved. On the 9th day after admission, the patient again experienced fever with a temperature of 38.1 ° C. The skin rash appeared again and gradually increased throughout the body. Laboratory tests: leukocyte 13.78 × 10 ~ 9 / L, eosinophil 0.113; alanine aminotransferase 187 U / L, aspartate aminotransferase 45 U / L, γ-glutamyl transferase 374 U / L, Lactate dehydrogenase 239 U / L. Diagnosis of carbamazepine-induced drug hypersensitivity syndrome, given methylprednisolone plus human immunoglobulin treatment, rash symptoms and liver function gradually improved. On the 16th day of admission, the patient presented with a rash again on both lower extremities and was relieved by methylprednisolone and symptomatic treatment.