联合应用阿糖胞苷和伊达比星致迟发性皮疹和皮肤色素沉着

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1例37岁男性急性粒-单核细胞白血病患者先后4次行阿糖胞苷联合伊达比星化疗,化疗期间除出现骨髓抑制、呕吐等不良反应外,无皮疹或皮肤损伤表现。第5次静脉滴注伊达比星(20 mg、1次/d,第1天)和阿糖胞苷(1 900 mg、1次/12 h,第1~4天)第4天,患者出现四肢皮肤轻微瘙痒,未行特殊处理。化疗结束后第2天,患者双侧面颊部出现明显的深褐色色素沉着,双侧腰部及背部出现红色丘疹。考虑与阿糖胞苷和伊达比星有关。给予马来酸氯苯那敏4 mg口服、1次/12 h,20%维生素C注射液5 ml+0.9%氯化钠注射液100 ml+10%葡萄糖酸钙注射液10 ml静脉滴注、1次/24 h。7 d后,患者腰背部红色丘疹消失;24 d后,面部色素沉着基本消失。“,”A 37-year-old male patient with acute myelomonocytic leukemia received cytarabine combined with idarubicin for 4 times. The patient did not develop rash or skin damage during the chemotherapy except for myelosuppression and vomiting. The patient developed slight itching on the extremities on the 4th day after the 5th intravenous infusion of idarubicin (20 mg once daily, on day 1) and cytarabine (1 900 mg once per 12 hours, on day 1 to 4), and no special treatment was given. On the 2nd day after finishing the chemotherapy, the patient developed obvious dark brown pigmentation on both cheeks and red papules on his back and bilateral waist, which was considered to be related to combination use of cytarabine and idarubicin. Chlorphenamine maleate 4 mg orally once per 12 hours, and IV infusions of 20% vitamin C injection 5 ml+0.9% sodium chloride injection 100 ml+10% calcium gluconate injection 10 ml once daily were given. Seven days later, the red papules on his back and waist disappeared; 24 days later, his facial pigmentation disappeared basically.
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