類固醇對於Allopurinol過敏症候群治療成效：一病例報告

Allopurinol在臨床上被廣泛應用來治療高尿酸血症及痛風。雖然大部分人對於Allopurinol都有很好的耐受性，不過仍然有少部分的人使用Allopurinol會產生嚴重的不良反應，特別是在慢性腎臟疾病的病患。Allopurinol過敏症候群(Allopurinol hypersensitivity syndrome AHS)，就是因為服用Allopurinol而產生的不良反應，雖然AHS發生率只有2%，而嚴重AHS的發生率則更低約為0.4%，但其致死率卻高達25-30%。本文報告一位54歲的男性患者，有高血壓、高血脂、糖尿病及慢性腎臟功能不全的病史，最近發現有高尿酸血症(11.1mg/dL)而開始服用Allopurinol，在服用24日後，因為逐漸發生皮膚紅疹搔癢、口腔潰瘍、發燒、畏寒以及眼睛不適，一週之後到醫院就醫，經診斷為服用Allopurinol所造成之史帝文森－強生症候群(Stevens-Johnson syndrome)，因而在皮膚科住院接受治療，由於病人有高血壓、高血脂及糖尿病，所以入院後僅以支持療法，並未給予全身性類固醇，然而病人之病況惡化，併有腎功能惡化，因而於住院兩日後，轉進腎臟科病房，在使用全身性類固醇治療之後，病況持續改善，並在2週後出院。總之，Allopurinol仍是目前臨床上最常用於治療高尿酸血症的藥品，雖然其產生AHS的機率不高，但是一旦產生，其致死率卻相當高。雖然類固醇療法在許多案例中均有成效，但由於可能使感染機會增加及調整劑量的困難，因此不建議在一開始就使用類固醇，但對於嚴重的AHS病患，在支持療法後仍不見症狀改善時，可考慮使用類固醇並留意感染的徵兆。

關鍵字

Allopurinol ；過敏反應；類固醇；史蒂文森強生症候群

並列摘要

Allopurinol, an analogue of hypoxanthine, has been widely used in clinical practice for treatment of hyperuricemia and gout. Although it is generally well tolerated, a small number of patients may develop a cutaneous rash, especially in the patients with chronic kidney disease. Allopurinol hypersensitivity syndrome (AHS), characterized by skin rash, fever, leukocytosis, eosinophilia, aminotransferase elevation, is an infrequent but lifethreatening adverse effect of Allopurinol therapy. Because corticosteroid can modify the immunological process which is considered the major mechanism involved in AHS, it is used to treat AHS clinically. However, corticosteroid therapy may have deleterious effect (e.g., delayed healing of cutaneous lesions, infections, prolonged hospital stay). Therefore, the use of corticosteroids for AHS remains controversial. We reported a 54-year-old man who had underlying diabetes mellitus with chronic renal insufficiency, hypertension and hyperlipidemia. Allopurinol 100mg twice a day was initiated one month prior to admission. After taking the drug for 24 days, he developed a generalized mild itchy eruption on the trunk and upper extremities followed by chillness, fever, ocular discomfort and painful oral ulcer over one-week period and was admitted to the hospital. A skin biopsy revealed changes consistent with Stevens-Johnson syndrome. Overall, Allopurinol is still the most often prescribed drug for hyperuricemia in clinical practice. Although the incidence rate of AHS is rare, its mortality rate is high once it happens. Steroid therapy showed benefits in some case reports, however, it is hard to titrate the dose under considerations of increasing infection probability. Therefore, we don't suggest steroid therapy as an initial treatment for all AHS patients. In severe AHS cases, without expected response to supportive care, steroid therapy and close monitoring infection signs are recommened.

並列關鍵字

allopurinol ； Hypersensitivity ； Corticosteroid ； Stevens-Johnson Syndrome

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類固醇對於Allopurinol過敏症候群治療成效：一病例報告

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