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1例24岁男性癫痫患者长期口服丙戊酸钠疗效不佳。后改为口服复方苯巴比妥溴化钠1片,3次/d;复方苯硝那敏片午餐后2片,晚餐后1片;九龙化风丸4丸,3次/d。服药约1个半月后患者颜面、躯干、上肢等部位出现红色斑丘疹,后蔓延至全身,伴有口唇溃烂、高热、颜面部水肿、咳嗽咯痰。停用上述药物。实验室检查:丙氨酸转氨酶(ALT)742 U/L,天冬氨酸转氨酶(AST)279 U/L,碱性磷酸酶406 U/L,γ-L-谷氨酰转肽酶1123 U/L,C反应蛋白57.4 mg/L,肌酸激酶235 U/L,肌酸激酶同工酶60 U/L,α-羟丁酸脱氢酶561 U/L,乳酸脱氢酶899 U/L。诊断为抗癫痫药联用所致药物超敏综合征,给予甲泼尼龙静脉注射治疗。治疗6 d后,患者症状明显改善,复查肝功能:ALT 165 U/L,AST 55 U/L。入院第25天,患者痊愈出院。
Long-term oral administration of valproate in a 24-year-old male with epilepsy was ineffective. After the change to oral compound phenobarbital sodium bromide 1, 3 times / d; compound benzene nitrendil tablets 2 after lunch, 1 after dinner; Kowloon salicylic acid pills 4 pills 3 times / d. About 1 and a half months after taking the drug, the patient’s face, trunk, upper limbs and other parts appear red rash, then spread to the whole body, accompanied by lip ulcers, fever, facial edema, cough and expectoration. Disable the above drugs. Laboratory tests: Alanine aminotransferase (ALT) 742 U / L, aspartate aminotransferase (AST) 279 U / L, alkaline phosphatase 406 U / L, γ-L-glutamyl transpeptidase 1123 U / L, C reactive protein 57.4 mg / L, creatine kinase 235 U / L, creatine kinase isoenzyme 60 U / L, a-hydroxybutyrate dehydrogenase 561 U / L, lactate dehydrogenase 899 U / L. Diagnosed as antiepileptic drug-induced drug hypersensitivity syndrome, given methylprednisolone intravenous therapy. After 6 days of treatment, the symptoms of the patients were significantly improved. The liver function was reviewed: ALT 165 U / L and AST 55 U / L. On the 25th day of admission, the patient was discharged.