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中毒性表皮坏死松解症是一类临床罕见但严重威胁患者生命的重症药疹,死亡率高达30%~50%。儿童中最常见致敏药物为抗癫痫药、抗生素和解热镇痛药。化疗药物引发中毒性表皮坏死松解症报道少见。本文报道一例2岁肾母细胞瘤患儿经更生霉素联合长春新碱化疗1周后并发严重皮肤药物不良反应——中毒性表皮坏死松解症。本报道旨在提醒肿瘤科医生警惕肿瘤患者治疗过程中发生中毒性表皮坏死松解症这一高致死性重症药疹的可能,需要在临床中密切观察患儿皮肤表现,一旦出现相应症状须立即作为危重症处理;同时提示皮肤科医生警惕化疗药更生霉素有引发中毒性表皮坏死松解症的可能,发现此类病人用药时出现皮疹应重视。早期识别并停用可疑药物,联合积极支持治疗可显著改善患者预后,降低死亡率。
Toxic epidermal necrolysis is a class of clinical rare but serious threat to the lives of patients with severe drug eruption, the mortality rate as high as 30% to 50%. The most common sensitizing drugs in children are antiepileptic drugs, antibiotics and antipyretic analgesics. Chemotherapy drugs induced toxic epidermal necrolysis reported rare. This article reports a case of 2-year-old Wilms tumor in children with dermatomycin combined with vincristine chemotherapy for 1 week after severe dermal drug adverse reactions - toxic epidermal necrolysis. The purpose of this report is to remind oncologists to warn tumor patients of toxic epidermal necrolysis of toxic epidermal necrolysis of the highly lethal severe drug rash may need to be closely observed in clinical children with skin manifestations, in the event of the corresponding symptoms should be immediately as Critical treatment; also prompts dermatologists to guard against chemotherapy drugs dactinomycin inducing toxic epidermal necrolysis may be found in such patients should pay attention to rash when medication. Early identification and discontinuation of suspected drugs, combined with active supportive care can significantly improve patient outcomes and reduce mortality.