Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Following Use of Allopurinol and Relapse during Rapid Tapering of Corticosteroid

Allopurinol引起之伴隨嗜伊紅性白血球增加與全身症狀的藥物反應與類固醇快速減量造成復發之案例報告

周丹薇(Tan-Wei Chew) ； 林淑文(Shu-Wen Lin) ； 林慧玲(Fe-Lin Lin Wu) ； 高芷華(Tze-Wah Kao) ； 蕭斐元(Fei-Yuan Hsiao)

《臺灣臨床藥學雜誌》 22卷3期 (2014/09) Pp. 149-157

https://doi.org/10.6168/FJCP.2014.2203.03

摘要

目的：藥物疹合併嗜伊紅血症及全身症狀（DRESS）為一種可能侵犯內臟的延遲性藥物過敏反應。在糖質類固醇治療突然中斷時，此過敏反應的再發並不少見。此文章描述一位發生DRESS的病人，在以糖質類固醇治療時由於降低劑量過快而造成病情惡化。案例說明：一位患有第五期慢性腎病的50歲男性服用allopurinol約2個月後，因發燒、呼吸困難、臉部浮腫、全身皮疹被送到急診。病人後來被診斷為allopurinol導致之DRESS，並開始全身性糖質類固醇治療。我們每日給予病人120 mg注射的methylprednisolone，並逐漸減量轉為口服prednisolone，病人的臨床症狀與實驗室檢驗都有明顯的進步。然而，病人的症狀卻在某次降低糖質類固醇劑量時復發了，因此我們恢之前的劑量，並減緩為每4~5日減量一次。病人的皮疹與臉腫在之後已改善。結論：Allopurinol導致之DRESS為一特別且可能致死的皮膚不良反應。臨床工作者應緩慢地降低糖質類固醇治療的計量並密切監測病人，注意復發的情況出現。

關鍵字

伴隨嗜伊紅性白血球增加與全身症狀的藥物反應 ； 過敏症候群 ； 糖質類固醇 ； 急性腎損傷

並列摘要

Objective: DRESS (drug reaction with eosinophilia and systemic symptoms) is a delayed-type hypersensitivity reaction with involvement of internal organs. It is not uncommon for the reaction to flare up due to abrupt withdrawal of corticosteroid therapy. We report a patient who developed DRESS associated with acute flare up during tapering of corticosteroid. Case Summary: A 50-year-old man with stage V CKD was brought to our emergency department with fever, dyspnea, facial swelling, and generalized skin rash after taking allopurinol for 2 months. The diagnosis of allopurinol induced DRESS was made and the patient was started on systemic corticosteroids. Intravenous methylprednisolone 120 mg/day was given, follow with slowly tapering of dosage to oral prednisolone. However, symptoms relapsed during corticosteroid tapering. We resumed the previous dose and tapered the dose every 4 ~ 5 days. Thereafter, patient's skin rash and facial edema resolved. Conclusion: Allopurinol induced DRESS is a distinct and potentially fatal cutaneous adverse reaction. Clinicians should gradually taper corticosteroid therapy and closely monitor patient for the emergence of possible relapse.

並列關鍵字

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) ； Hypersensitivity Syndrome ； Allopurinol ； Corticosteroid ； Acute Kidney Injury