下咽癌術後放射治療併口服Phenytoin引發史帝文-強森症候群—病例報告

Stevens-Johnson Syndrome in a Patient of Hypopharyngeal Carcinoma Receiving Phenytoin and Postoperative Radiotherapy-Case Report

林芳永(Fang-Yung Lin) ； 王仲祺(Chen-Chi Wang) ； 許振益(Chen-Yi Hsu)

《中華民國耳鼻喉科醫學雜誌》 37卷6期 (2002/10) Pp. 447-451

https://doi.org/10.6286/2002.37.6.447

摘要

史帝文–強森症候群（Stevens–Johnson syndrome）是一種與藥物、病毒感染及放射線治療等因素有關之嚴重皮膚病變，其致死率不容臨床大夫輕忽。曾有報導指出若病人同時服用抗癲癇藥物且接受放射線治療，似乎更容易誘發此症候群。本科於2001年7月經歷一46歲男性下咽癌病人，該病人於2001年5月接受全喉切除術等手術治療，且於6月起接受頸部放射線治療。該病患有頭部外傷接受手術之紀錄，由於放射線治療的這段時間裏有癲癇發作之情況，因此於7月起開始給予抗癲癇藥物phenytoin服用。於放射線治療結束後第3天起，該病患開始先是於頸部出現泛紅及水泡之病變，臨床上和尋常的放射線皮膚炎有些微差異，緊接著身體軀幹、會陰部、四肢及手、腳掌等部位亦出現相似之病變，口腔黏膜及眼結膜也受到侵犯，經診斷為史帝文–強森症候群。所幸經停止使用phenytoin、積極實施清創術、換藥及施打免疫抑制劑cyclosporin後，病人皮膚病灶已經痊癒。一個看似常規的癌症病人治療過程卻發生如此嚴重的併發症，特提出報告並回顧相關文獻供同業參考。

關鍵字

放射線治療 ； 雙苯內醯尿 ； 抗癲癇藥物 ； 史帝文-強森症候群 ； 下咽癌

並列摘要

Stevens - Johnson syndrome is a severe dermatological disorder related to a combination of drug consumption, viral infection, incidence of Stevens-Johnson syndrome arises for patients receiving cranial irradiation and also oral anticonvulsants. We present the case of a 46 y/o male hypopharyngeal ca. patient who underwent a total laryngectomy and related surgery in May 2001, radiotherapy commencing in June, 2001. Subsequent to a craniotomy associated with a severe head injury in 2000 and a convulsive attack in early July, 2001, the patient was administered oral phenytoin for treatment, although, on July 27, 2001, three days subsequent to the completion of radiotherapy erythematous changes with vesicle formation arose over the patient's neck. Subsequently, similar lesions in addition to targetoid lesions developed over the trunk, scrotum, penile area, all four limbs, palms and feet, with the oral mucosa and conjunctiva also being involved. Stevens-Johnson syndrome being diagnosed. Fortunately, subsequent to the discontinuation of phenytoin treatment, aggressive debridement of the necrotic area, intravenous injection of prophylactic antibiotics and immunosuppressant treatment using cyclosporine, the lesions healed completely. From this case, we report that a routine irradiation therapeutic course for a cancer-suffering patient may be associated with such serious complication, and we thus review the relevant literature and present this article in order to stimulate further discussion.

並列關鍵字

radiotherapy ； phenytoin ； anticonvulsant ； Stevens-Johnson syndrome ； hypopharyngeal carcinoma