中华皮肤科杂志 ›› 2013, Vol. 46 ›› Issue (9): 621-625.

• 论著 • 上一篇    下一篇

肿瘤坏死因子α拮抗剂治疗一例伴嗜酸性粒细胞增多和系统症状药疹的临床观察

陈玲玲1,路丹丹2,施辛2,孙晓东3,4,谢立夏3,5,陈小建6,丁兰7,金维佳2,王勇飞2   

  1. 1. 南京医科大学附属苏州医院
    2. 苏州大学附属第二医院
    3. 苏州大学附属第二医院皮肤科
    4. 唐山市丰南区妇幼医院
    5. 成都市第二人民医院
    6. 南京医科大学附属苏州医院，苏州市立医院
    7. 无锡市儿童医院
  • 收稿日期:2012-10-16 修回日期:2013-02-05 出版日期:2013-09-15 发布日期:2013-09-01
  • 通讯作者: 施辛 E-mail:shx9@163.com

Drug rash with eosinophilia and systemic symptoms controlled by tumor necrosis factor-α antagonist: a clinical observation

  • Received:2012-10-16 Revised:2013-02-05 Online:2013-09-15 Published:2013-09-01

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摘要： 【摘要】 报告单独使用肿瘤坏死因子α成功治愈别嘌醇导致伴嗜酸性粒细胞增多和系统症状的药疹（DRESS）的经过。男性痛风患者，60岁，发病前20 d口服别嘌醇，发热、全身皮疹伴有肝肾功能损害、白细胞和嗜酸性粒细胞升高、淋巴结肿大，合并糖尿病。经皮下注射益赛普25 mg（首剂加倍），隔天1次，共8次，获得痊愈。首次注射后，发热即控制；1 d 后皮损不再扩大，2 d 后皮损开始脱屑，5 d 后表皮新生；外周血肿瘤坏死因子α逐渐下降，治疗5周降至正常范围。入院后外周血白细胞、C反应蛋白、胆红素仍持续上升，在注射3次后开始下降，2周内逐渐恢复。转氨酶在首次注射后开始下降，2周内恢复。外周血嗜酸性粒细胞在首次注射后持续上升，于第10天达高峰，之后缓慢下降，治疗5周后降至正常范围。提示，肿瘤坏死因子拮抗剂能在疾病早期快速、安全、有效地控制伴嗜酸性粒细胞增多和系统症状的药疹，但不能阻止嗜酸性粒细胞上升。 【关键词】 皮炎，剥脱性； 肿瘤坏死因子α； 治疗结果

关键词: 皮炎，剥脱性, 肿瘤坏死因子α, 治疗结果

Abstract: CHEN Ling-ling, LU Dan-dan, SHI Xin*, SUN Xiao-dong, XIE Li-xia, CHEN Xiao-jian, DING Lan, JIN Wei-jia, WANG Yong-fei. *Department of Dermatology, Second Affiliated Hospital of Soochow University, Suzhou 215004, China Corresponding author: SHI Xin, Email: shx9@163.com 【Abstract】 A case of allopurinol-induced drug rash with eosinophilia and systemic symptoms successfully controlled by tumor necrosis factor-α （TNF-α） antagonist is reported. A 60-year-old man with gout and diabetes was admitted to the hospital for generalized pruritic eruptions with fever for four days. Twenty days prior to the presentation he was given oral allopurinol for the treatment of gout, and four days before the admission, he developed generalized exfoliative dermatitis complicated by fever, liver and kidney damage, leukocytosis, eosinophilia and lymph node enlargement. After the admission, he was treated with subcutaneous injection of recombinant human TNF-α receptor Ⅱ once every other day with the initial dose being 50 mg/d and maintenance dose 25 mg/d. The patient healed after eight sessions of injection. In detail, fever dropped and was controlled immediately after the first injection, epidermal detachment stopped within 24 hours, desquamation began two days later, and re-epithelization started five days later. The serum level of TNF-α descended gradually and reached the normal range on week 5 after the beginning of treatment. White blood cell count as well as C-reactive protein and bilirubin levels in peripheral blood still continued to increase after the admission, began to decrease after three injections, and dropped gradually to the normal range within two weeks. Serum aminotransferase levels started to decrease after the first injection and returned to the normal range within two weeks. Peripheral eosinophil count continuously increased after the first injection, reached its peak on day 10, dropped gradually thereafter, and was restored to the normal range five weeks after the initiation of treatment. This case suggests that TNF-α antagonist used at early stage can control drug rash with eosinophilia and systemic symptoms rapidly, safely and effectively, but cannot prevent the increase of eosinophils. 【Key words】 Dermatitis, exfoliative; Tumor necrosis factor-α; Treatment outcome