疑似Quetiapine誘發Stevens-Johnson Syndrome之案例報告

Quetiapine-induced Stevens-Johnson Syndrome: A Case Report

謝蕙霞(Hui-Hsia Hsieh) ； 沈逸婷(Yi-Ting Shen) ； 吳天元(Tien-Yuan Wu) ； 陳綺華(Chi-Hua Chen)

《臺灣臨床藥學雜誌》 30卷1期 (2022/01) Pp. 68-78

https://doi.org/10.6168/FJCP.202201_30(1).0007

摘要

史蒂芬強森症候群（Steven-Johnson Syndrome, SJS）是眾所周知的嚴重黏膜皮膚不良反應，屬於第四型之過敏反應。最常見的原因是由藥物引起，約佔50%，其特點是發生率低但死亡率高。SJS每年的發生率為每一百萬人中有1～6個案，屬極為罕見。2014年泰國研究分析2002年至2014年與SJS相關藥物中quetiapine只有1個案例被報導過。本文敘述一位診斷為非小細胞肺癌第四期病患，因躁動、夜間偶爾會大呼小叫、睡不好，疑似使用quetiapine（Apo-Quetiapine®）後產生SJS嚴重藥物不良反應。此個案以Naranjo或ALDEN量表評估藥物與不良反應間的關聯性，得到的結果一致都是極有可能。進一步以SCORTEN scale疾病嚴重程度量表預估死亡率，本案例評估結果為3分，死亡率為35.3%。個案在停用藥物及採取相關治療後，皮膚已新生且恢復狀況良好，但後續仍因癌症末期導致多重器官衰竭病危而出院返家。本文提供醫師、藥師及護理人員在給予藥物治療期間應隨時留意病患狀況並評估危險因子，確保病患之用藥安全。

關鍵字

Quetiapine ； 史蒂芬強森症候群 ； 藥品不良反應

並列摘要

Stevens-Johnson syndrome (SJS), known as a severe mucocutaneous adverse reaction, is a type IV allergic reaction. Approximately 50% of SJS cases, characterized as low incidence diseases with high mortality rates, are drug-induced. The annual incidence of SJS ranges from 1 to 6 cases per million people per year. According to the clinical profiles of SJS in Thai patients that investigated the SJS-related drugs from 2002 to 2014, only 1 SJS case was reported as quetiapine-induced adverse drug reactions. The present study describes a patient diagnosed as non-small cell lung cancer stage IVA. Because of restlessness, occasional yelling at night, and poor sleep, the patient was given quetiapine (Apo-Quetiapine®). The patient developed severe SJS after taking quetiapine. This case was evaluated by the Naranjo scale and the ALDEN scale to assess the association between the drug and the adverse reaction. The results are consistent. Additional evaluation using the SCORTEN scale, the disease severity scale, showed a score of 3 points and approximately 35.3% of the mortality rate. After stopping the drug and giving relief medications, the patient's skin recovered. However, because of end-stage cancer and multiple organ failure, the patient was discharged from the hospital and returned home. Physicians, pharmacists, and nursing staff should pay more attention to a patient's condition and evaluate the risk factors at all times during drug treatment to ensure medication safety.

並列關鍵字

Quetiapine ； Steven-Johnson Syndrome (SJS) ； Adverse Drug Reaction