Adverse Drug Reactions Journal 2019;21(2):150-151
doi:10.3760/cma.j.issn.1008-5734.2019.02.018
Toxic epidermal necrolysis induced by combination of ceftriaxone, lysine acetylsalicylate and Qingkailing(清开灵)
Jike XIE 1 ; Yongfang HU ; Xuelian YAN
Affiliations
Keywords
Ceftriaxone; Anti-inflammatory agents,non-steroidal; Stevens-Johnson syndrome; TCM injection
Country
China
Language
Chinese
Abstract
A 30-year-old male patient received Ⅳ infusions of lysine acetylsalicylate 0.9 g dissolved in 0.9% sodium chloride injection 100 ml,ceftriaxone 4.0 g and dexamethasone 5 mg together dissolved in 0.9% sodium chloride injection 250 ml,and Qingkailing injection 30 ml dissolved in 5% glucose injection 250 ml once daily for 2 days in a local clinic for common cold.On day 3 of the drugs withdrawal,the patient developed rash on multiple parts of both hands,accompanied by pruritus.The next day,he developed fever and his body temperature rose to 40 ℃.Over the next few days,the rash gradually spread to his whole body and herpes appeared.Laboratory tests showed that alanine aminotransferase 1 012 U/L,aspartate aminotransferase 413 U/L,total bilirubin 92.5 μ mol/L,and direct bilirubin 72.1 μmol/L.Seven days after the onset of rash,the area of skin lesions,blisters,and exfoliation respectively reached 60%-70%,20%-30%,and > 30% of his body surface area.The patient was diagnosed with toxic epidermal necrolysis complicated with liver injury.The Ⅳ infusions of methylprednisolone and immunoglobulin and symptomatic support treatments including timely skin care,hepatoprotective drugs,and anti-infection drugs were given,and his skin lesions gradually improved.After 7 days of treatments,methylprednisolone was changed to be taken orally and gradually reduced to discontinuation.Symptomatic treatments such as hepatoprotective therapy lasted for more than 3 weeks.After 40 days,his skin lesions healed.
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