背景:史蒂文斯-约翰逊综合征-中毒性表皮坏死松解症(SJS-TNE)重叠是一种罕见的以红斑为特征的皮肤病,水泡,广泛的剥脱,表皮脱离,多个粘膜受累,和积极的Nikolsky\的标志。SJS-TEN的死亡率很高。我们的病例涉及罕见的药物诱发的Stevens-Johnson综合征-毒性表皮坏死松解症重叠,在喹硫平和法莫替丁治疗的情况下延迟发作。
方法:一名82岁的台湾女性因尿量减少入院,全身性水肿,和多个皮肤水泡和褥疮。随着病变的进一步扩散,多个破裂的大疱,脸上有浅的侵蚀,树干,四肢和粘膜受累影响了全身表面积的20%。Nikolsky的信号是积极的。高度怀疑史蒂文-约翰逊综合征的诊断。一个月前,她开始使用法莫替丁和喹硫平。开始静脉注射甲基强的松龙治疗,3天后改善皮肤病变。然而,甲基强的松龙逐渐减少仅1天后出现新的病变。患者入院后12天死亡。
结论:Stevens-Johnson综合征-中毒性表皮坏死松解症是一种罕见的皮肤病。虽然它主要是急性的,死亡率很高,延迟发作仍然可能发生。喹硫平和法莫替丁通常安全有效地治疗老年病和胃肠道疾病,但罕见的药物超敏反应会导致衰弱的后果。因此,提高临床意识和开始支持治疗势在必行.仍然缺乏最佳的管理指南,需要通过随机对照试验确认制定的指南.有必要为更好的管理策略进行合作。
BACKGROUND: Stevens-Johnson syndrome-toxic epidermal necrolysis (SJS-TNE) overlap is a rare skin disorder characterized by erythema, blisters, extensive exfoliation, epidermal detachment, the involvement of multiple mucosae, and positive Nikolsky\'s sign. SJS-TEN has a high mortality rate. Our case involves a rare occurrence of drug-induced Stevens-Johnson syndrome-toxic epidermal necrolysis overlap with a delayed onset in the setting of quetiapine and famotidine therapy.
METHODS: An 82-year-old Taiwanese female was admitted to our hospital for decreased urine output, generalized edema, and multiple skin blisters and bedsores. With further spread of the lesions, multiple ruptured bullae with shallow erosions on the face, trunk, and limbs and mucosal involvement affected 20% of the total body surface area. Nikolsky\'s sign was positive. A diagnosis of Steven-Johnson syndrome was highly suspected. One month prior, she had started famotidine and quetiapine. Intravenous methylprednisolone treatment was initiated, which ameliorated the skin lesions after 3 days. However, new lesions developed after only 1 day of methylprednisolone tapering. The patient died 12 days after admission.
CONCLUSIONS: Stevens-Johnson syndrome-toxic epidermal necrolysis is a rare skin disorder. Although it is mainly acute and has a high mortality rate, delayed onset can still occur. Quetiapine and famotidine are generally safe and effective for treating geriatric and gastrointestinal problems, but rare drug hypersensitivity reactions can lead to debilitating consequences. Therefore, increased clinical awareness and the initiation of supportive care are imperative. Optimal management guidelines are still lacking, and confirmation of developed guidelines through randomized controlled trials is needed. Collaboration for better management strategies is warranted.