背景:SJS/TEN等严重皮肤药物不良反应(ADR)的病例综述为临床特征提供了有用的见解,推定药物,和管理协议。
方法:回顾性分析2010年至2019年间住院的62例(m:f-20:42)SJS/TEN患者的临床特征,推定药物及其适应症,皮外并发症,和治疗结果。诊断是基于既定标准的临床诊断。WHO-UMC报告ADR量表和ALDEN算法评分用于因果关系评估。疗法是根据内部资源和负担能力定制的。
结果:病例包括SJS(41.9%),SJS/TEN重叠(33.9%),年龄在4-85岁之间的TEN(24.2%)。并发症包括转氨酶(69.4%),淋巴结肿大(15.5%),败血症(11.3%),和伤口感染(4.8%)。芳香抗惊厥药(37.1%),改善疾病的抗风湿药(25.8%),抗逆转录病毒药物(12.9%),非甾体抗炎药(8.1%),抗菌药物(4.8%),苯并苯三酮(3.2%)是主要的推定药物。平均潜伏期为16.6天。观察到的8%死亡率是由于原发性合并症或多器官衰竭。增加新鲜输血(BT,n=11)或IVIg(n=7)对全身性皮质类固醇显示皮肤压痛的早期缓解,改善一般状况,和重新上皮化。只有16%的患者出现后遗症。
结论:芳香抗惊厥药,别嘌呤醇,奈韦拉平,复方新诺明,扑热息痛,双氯芬酸仍然是最有牵连的药物.柳氮磺吡啶,来氟米特,乙胺丁醇,和三己苯基是不常见的添加。早期短期服用大剂量地塞米松是有用的。添加BT或IVIg可迅速缓解。先前存在的艾滋病毒疾病,肾病,和败血症仍然是重要的住院死亡。回顾性研究设计和少数病例仍然是主要的局限性。
BACKGROUND: Case reviews of severe cutaneous adverse drug reactions (ADRs) such as SJS/TEN provide useful insights for clinical characteristics, putative drugs, and management protocols.
METHODS: Medical charts of 62 (m:f- 20:42) patients with SJS/TEN hospitalized between 2010 and 2019 were analyzed retrospectively for clinical attributes, putative drugs and their indications, extracutaneous complications, and therapeutic outcome. The diagnosis was clinical based on established criteria. WHO-UMC scale for reporting ADR and ALDEN algorithm score were used for causality assessment. Therapies were customized based on in-house resources and affordability.
RESULTS: Cases included were SJS (41.9%), SJS/TEN overlap (33.9%), and TEN (24.2%) aged 4-85 years. Complications included transaminitis (69.4%), lymphadenopathy (15.5%),
septicemia (11.3%), and wound infections (4.8%). Aromatic anticonvulsants (37.1%), disease-modifying antirheumatic drugs (25.8%), antiretroviral drugs (12.9%), non-steroidal anti-inflammatory drugs (8.1%), antimicrobials (4.8%), and trihexyphenidyl (3.2%) were major putative drugs. The mean latent period was 16.6 days. The observed 8% mortality was because of primary comorbidities or multiorgan failure. Addition of fresh blood transfusion (BT, n = 11) or IVIg (n = 7) to systemic corticosteroids showed early relief in skin tenderness, improvement in general condition, and re-epithelialization. Only 16% of patients developed sequelae.
CONCLUSIONS: Aromatic anticonvulsants, allopurinol, nevirapine, cotrimoxazole, paracetamol, and diclofenac remain the most implicated drugs. Sulfasalazine, leflunomide, ethambutol, and trihexyphenidyl were uncommon additions. A short course of high-dose dexamethasone in the early stage was useful. Addition of BT or IVIg provided rapid relief. Preexisting HIV disease, kidney disease, and sepsis remain important for in-hospital deaths. Retrospective
study design and small number of cases remain major limitations.