1例疑似头孢菌素类与碳青霉烯类交叉过敏致DRESS病例报道-中国药房

1例疑似头孢菌素类与碳青霉烯类交叉过敏致DRESS病例报道

请在关注微信后，向客服人员索取文件

篇名：	1例疑似头孢菌素类与碳青霉烯类交叉过敏致DRESS病例报道
TITLE：	DRESS caused by suspected cross-allergy between cephalosporins and carbapenems：a case report
摘要：	目的探讨头孢菌素类与碳青霉烯类交叉过敏导致伴嗜酸性粒细胞增多和系统症状的药物反应（DRESS）的发病机制、诊断、治疗等，为临床安全用药提供参考。方法分析临床药师参与我院1例高龄重症肺炎患者因疑似头孢菌素类与碳青霉烯类交叉过敏所致DRESS的诊疗过程，并文献汇总DRESS的发病机制、诊断、治疗以及头孢菌素类与碳青霉烯类交叉过敏的有关研究。结合本例患者临床表现、治疗经过，讨论头孢菌素类与碳青霉烯类交叉过敏的可能机制及DRESS的治疗策略。结果本例患者RegiSCAR评分6分，为DRESS确诊病例，且可能存在β-内酰胺环特异性的人类白细胞抗原等位基因或T细胞受体，从而导致疑似头孢菌素类与碳青霉烯类交叉过敏反应。临床药师建议停用头孢菌素类与碳青霉烯类药物，使用甲泼尼龙联合免疫球蛋白进行治疗。临床医生采纳临床药师建议，患者后续未再发热且皮疹逐日消退。结论头孢菌素类与碳青霉烯类存在交叉过敏导致DRESS的可能。对出现DRESS的患者建议及时排查可疑药物并停药；糖皮质激素联合免疫球蛋白是可行的治疗方案，有条件的医疗机构应进行疱疹病毒筛查和治疗。
ABSTRACT：	OBJECTIVE To explore the pathogenesis， diagnosis and treatment of drug reaction with eosinophilia and systemic symptoms （DRESS） caused by cross-allergy between cephalosporins and carbapenems， and provide reference for safe clinical medication. METHODS Clinical pharmacists participated in the diagnosis and treatment process of a patient with severe pneumonia whose DRESS caused by suspected cross-allergy between cephalosporins and carbapenems in our hospital. At the same time， relevant studies on the pathogenesis， diagnosis， treatment， and cross-allergy between cephalosporins and carbapenems were retrieved for analysis. Based on the clinical manifestations and treatment process of this patient， the possible mechanisms of cross- allergy between cephalosporins and carbapenems and the treatment strategies for DRESS were discussed. RESULTS The RegiSCAR score of this patient was 6 points， confirming the diagnosis of DRESS. There may be β-lactam ring-specific human leucocyte antigen alleles or T-cell receptors， which led to suspected cross-allergic reactions between cephalosporins and carbapenems. The clinical pharmacists suggested discontinuing cephalosporins and carbapenems and using methylprednisolone combined with immunoglobulin for treatment. The physician adopted the pharmacist’s suggestion， and the patient did not have fever again and the rash gradually subsided. CONCLUSIONS There is a possibility of cross-allergy between cephalosporins and carbapenems causing DRESS. For patients with DRESS， it is recommended to promptly investigate the suspected drugs and discontinue them. The combination of glucocorticoids and immunoglobulin is a feasible treatment option. Medical institutions with conditions should conduct herpesvirus screening and treatment.
期刊：	2025年第36卷第15期
作者：	何璐；钱妍
AUTHORS：	HE Lu，QIAN Yan
关键字：	伴嗜酸性粒细胞增多和系统症状的药物反应；药物超敏反应综合征；嗜酸性粒细胞增多；β-内酰胺类；过敏反应
KEYWORDS：	drug reactions with eosinophilia and systemic symptoms； drug hypersensitivity syndrome； eosinophilia； β-lactams；
阅读数：	11 次
本月下载数：	0 次

* 注：未经本站明确许可，任何网站不得非法盗链资源下载连接及抄袭本站原创内容资源!在此感谢您的支持与合作！