GINORYA, CHANEY-CATCHPOLEM, DEMETREE JM, et al.Drug reaction with eosinophilia and systemic symptoms (DRESS) in anadolescent treated with lamotrigine[J]. J Pediatr Pharmacol Ther,2013, 18(3): 236-240.
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a hypersensitivity syndrome most commonly associated with antiepileptic agents, allopurinol, and sulfonamides. It is a severe adverse reaction associated with fever, rash, eosinophilia, lymphadenopathy, and internal organ involvement. We present the case of a 17-year-old Caucasian female with bipolar disorder type II and posttraumatic stress disorder treated with lamotrigine for a non-Food and Drug Administration-approved indication that developed DRESS syndrome at an initial dose higher than that recommended. Her symptoms were atypical in that she developed a rash with influenza-like symptoms that resolved after discontinuation of lamotrigine and returned 8 days later. She was hospitalized because of elevated liver enzymes and treated with corticosteroids. In patients presenting with rash and systemic symptoms, DRESS syndrome should be considered and treated appropriately to reduce mortality, which can be as high as 10%. Treatment includes withdrawal of the offending agent and corticosteroids.
正1病例介绍患者男,44岁。因突发头痛伴全身乏力2周余,胡言乱语6 d于2011年4月8日入院。入院诊断"病毒性脑炎"。查体:体温37.5℃,脉搏85次/min,呼吸21次/min,血压125/78 mm Hg(1 mm Hg=0.133 kPa)。神志清楚,精神差,慢性病容。入院后曾多次发生痫性大发作,实验室检查:血常规:白细胞计数13.38×109/L,中性分叶核粒细胞91.9%;生化检查:氯
AURICH-BARRERAAB, WILTONL, BROWND, et al.Paediatric postmarketing pharmacovigilance using prescription-event monitoring: comparison of the adverse event profiles of lamotrigine prescribed to children and adults in England[J]. Drug Saf, 2010, 33(9):751-763.
Conclusions: This study demonstrated that signal detection methods can be used to detect quantitative and qualitative differences in the AE profiles between the first children and adults taking a newly licensed drug.
ELZAGALLAAI AA, GARCIA BOURNISSENF, FINKEL STEINY,et al.Severe bullous hypersensitivity reactions after exposure to carbamazepine in a Han Chinese child with a positive HLA B* 1502 andnegative in vitro toxicity assays: evidence for different pathophysiological mechanisms[J]. J Popul Ther Clin Pharmacol,2011,18(1): e1-e9.
BACKGROUND: syndrome () can present in several clinical forms ranging from simple maculopapular to severe bullous reactions and multi-system dysfunction. Genetic analysis of patients has revealed a striking association between carbamazepine (CBZ)-induced severe bullous reactions, such as Steven-Johnson Syndrome, and in individuals from Southeast Asia who carry a specific HLA allele (*1502). This ethnic-specific relationship with a disease phenotype has raised the question of the commonality of the mechanisms of these diseases. The aim of this study was to investigate the genetic and metabolic bases of to help predict patient susceptibility.: A case of carbamazepine-induced Steven-Johnson Syndrome reaction in a *1502 positive child of Han Chinese origin, a carbamazepine-induced case in a Caucasian patient and 3 healthy controls were investigated. We performed two types of in vitro toxicity assay, the lymphocyte toxicity assay () and the novel in vitro platelet toxicity assay (iPTA) on cells taken from the Chinese child 3 and 9 months after recovery from the reaction and from two healthy volunteers. We also tested the Caucasian patient, who developed CBZ-induced , 3 months after the reaction.: Both and iPTA tests were negative 3 and 9 months after the reaction on samples from the Chinese child whereas the tests were positive in the Caucasian patient.: These results strongly suggest more than one mechanistic pathway for different CBZ-induced hypersensitivity reactions in patients with different ethnic backgrounds.
DREDGE DC, PARSONS EC, CARTER LP,et al.Anti-convulsant hypersensitivity syndrome treated with intravenous immunoglobulin[J].Pediatr Neurol,2010,43(1):65-69.
<p id="simple-para0055">Anticonvulsant hypersensitivity syndrome is a severe, potentially life-threatening, reaction to the aromatic anticonvulsant medications. Reported here is a case of anticonvulsant hypersensitivity syndrome secondary to phenobarbital in a 2-year-old boy; he responded to drug withdrawal, corticosteroids, and intravenous immunoglobulin. The literature regarding treatment of this syndrome is reviewed.</p>
患者1,女,9岁,体质量26 kg。因服用拉莫三嗪后发热伴皮疹2 d,于2013年9月10日入院。患儿2年前在当地医院确诊为癫,之后一直服用托吡酯片。10余天前患儿突然抽搐,1 d 内抽搐2次。表现为双眼凝视,四肢抖动,口吐白沫,呼之不应。在当地医院抢救治疗,加服拉莫三嗪片(三金集团湖南三金制药,规格：25 mg,批号：130301)12.5 mg,bid(初始剂量)后出院。4 d 前增加至25 mg,bid,1 d 前患儿开始发热(当时未测体温),次日凌晨患儿体温升至39℃,面部出现红色斑丘疹,渐加深呈暗红色,迅速波及全身,皮疹渐融合成片,伴瘙痒。我院门诊予“葡萄糖酸钙、维生素 C、地塞米松、炎琥宁”静脉滴注治疗后收治入院。患儿既往有口服卡马西平过敏史。入院体检：体温36.8℃,脉搏88次.min－1,呼吸20次.min－1。全身皮肤及颜面部见暗红色斑丘疹,呈充血性,部分融合成片,疹间有正常皮肤,口唇干燥皲裂,口腔黏膜充血明显,未见溃烂,咽红。
Paediatric postmarketing pharmacovigilance using prescription-event monitoring: comparison of the adverse event profiles of lamotrigine prescribed to children and adults in England
Severe bullous hypersensitivity reactions after exposure to carbamazepine in a Han Chinese child with a positive HLA B* 1502 andnegative in vitro toxicity assays: evidence for different pathophysiological mechanisms
, 闫荟羽, 李艳娇, 张晓荧, 李月阳
