Cefadroxil tablets induced-drug hypersensitivity syndrome complicated with acute myocarditis and death
10.3760/cma.j.issn.1008-5734.2019.01.010
- VernacularTitle:头孢羟氨苄片致药物超敏综合征并发急性心肌炎死亡
- Author:
Shujie DONG
1
;
Ke CAO
;
Suodi ZHAI
Author Information
1. 北京大学第三医院药剂科 100191
- Publication Type:Journal Article
- Keywords:
Cefadroxil;
Drug hypersensitivity syndrome;
Myocarditis;
Death
- From:
Adverse Drug Reactions Journal
2019;21(1):55-56
- CountryChina
- Language:Chinese
-
Abstract:
A 61-year-old female patient took cefadroxil tablets 0. 5 g twice daily herself due to fever after blepharorrhaphy in her right eye. Her temperature returned to normal,but the medication was not discontinued and 2 weeks later,the patient developed skin rash on her limbs with severe itching,and fever (39 ℃). Then cefadroxil tablets were stopped but her symptoms were gradually aggravated,and then facial swelling appeared 5 days later. On the seventh day of onset,she was admitted to the hospital,with white blood cell count 25 × 109 / L,percentage of eosinophils 0. 29,eosinophil count 7. 4 × 109 / L,and normal liver and kidney function,myocardial enzymes,and electrocardiogram. Antiallergic and symptomatic treatments were given after the admission. On day 4 of admission,the patient developed dizziness and general fatigue. Her blood pressure was 96 / 61 mmHg and her heart rate was 110 beats per minute. The electrocardiogram showed multilead ST segment elevations and the echocardiography revealed a small amount of pericardial effusion. Laboratory tests showed that the cardiac troponin T (cTnT)was 1. 52 μg/ L,creatine kinase (CK)was 236 U/ L,CK-MB was 63 U/ L,and N-terminal pro-brain natriuretic peptide (NT-proBNP)was 9708 ng/ L. The patient was diagnosed with drug hypersensitivity syndrome complicated with acute myocarditis and pericarditis. Intravenous infusion of high dose methylprednisolone (500 mg/ d), human immunoglobulin (40 g/ d),and myocardial nutrition treatments were given. On day 5 of admission, the patient was transferred to the cardiovascular care unit (CCU),when her blood pressure was 80 / 50 mmHg,CK was 498 U/ L,CK-MB was 98 U/ L,cTnT was 5. 33μg/ L,and left ventricular ejection fraction was 55％ . However,the patient′ myocarditis and pericarditis progressed rapidly. On day 3 in the CCU,the laboratory tests showed CK 1252 U/ L,CK-MB 231 U/ L,cTnT 4. 57 μg/ L,NT-proBNP 17979 ng/ L,and left ventricular ejection fraction 10％,which then decreased to 5％ on day 6. Finally,the patient died on day 9 in the CCU.
