PDF(Pubmed)
Abstract：
Drug hypersensitivity reactions (DHRs) manifested as vasculitis are rare. Antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), sulphonamides, diuretics, immunosupressants and anticonvulsants are the most common culprits for drug-induced leukocytoclastic vasculitis (LCV) but there is scarce information about barbiturates. We present a case of 53-year-old female with severe vasculitis after phenobarbital- and NSAIDs-containing medications use. The preliminary diagnosis of drug-induced vasculitis was made based on anamnestic and clinical data. Further examinations confirmed the diagnosis of LCV and excluded other more common causes of vasculitis. The causative significance of used medications was assessed by long-term observation of the patient after the reaction, including the drug challenge series and Naranjo\'s Adverse Drug Reaction Probability Scale. It was concluded that phenobarbital is the most probable culprit drug. The patient\'s data were included in the Armenian Registry of Patients with Severe DHRs. Since then, the patient has avoided only barbiturate-containing drugs and no reactions were noted. Thus, the case indicates that even with limited diagnostic capabilities, the final diagnosis of rare drug-induced LCV and even rarer culprit drug can be established by comparing the available data. Awareness about phenobarbital and proper recording of the case are important in the management and prevention of DHRs manifested as vasculitis.
摘要：
表现为血管炎的药物超敏反应（DHRs）很少见。抗生素,非甾体抗炎药（NSAIDs），磺酰胺,利尿剂,免疫抑制剂和抗惊厥药物是药物诱导的白细胞碎裂性血管炎(LCV)的最常见元凶,但有关巴比妥类药物的信息很少.我们介绍了一例53岁女性，在使用含有苯巴比妥和NSAIDs的药物后患有严重血管炎。根据记忆和临床资料，对药物性血管炎进行了初步诊断。进一步的检查证实了LCV的诊断，并排除了其他更常见的血管炎原因。通过反应后对患者的长期观察来评估所用药物的致病意义，包括药物挑战系列和Naranjo的药物不良反应概率量表。结论苯巴比妥是最可能的罪魁祸首药物。患者的数据包括在亚美尼亚重度DHR患者登记处。从那以后,患者仅避免使用含有巴比妥酸盐的药物,未发现任何反应.因此，该案例表明，即使诊断能力有限，通过比较现有数据,可以确定罕见药物诱导的LCV甚至更罕见的罪魁祸首药物的最终诊断.对苯巴比妥的认识和对病例的适当记录对于治疗和预防表现为血管炎的DHR很重要。
