A case of fixed drug eruption caused by loxoprofen sodium hydrate
A case of fixed drug eruption caused by loxoprofen sodium hydrate
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洛索洛芬钠水合物致固定性药疹1例
DOI：
10.1016/j.alit.2015.04.007
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发表时间：
2015
影响因子：
6.8
通讯作者：
Katoh N.
中科院分区：
文献类型：
--
作者：
Nakai N;Katoh N.
固定性药疹（FDE）是一种皮肤不良药疹，其特征是再次暴露于药物后在相同部位复发的皮肤病变。它可以发生为单个或多个病变，影响身体的任何部位，好发于生殖器，手和嘴唇。1洛索洛芬钠水合物3（LX-P）（Loxonin; Daiichi Sankyo Co.，Ltd，Tokyo，Japan）是一种非甾体类抗炎药（NSAID），于1986年在日本获得批准。阿莫西林水合物4（AMPC）（Sawacillin; Astellas Pharma Inc.，日本东京）是一种抗生素，于1974年在日本获得批准。在此，我们报告一例38岁男性被诊断为由LX-P引起的FDE。一名38岁男性在我院急诊科就诊，诊断和治疗唇和口腔内粘膜糜烂，已存在3天。在他第一次到急诊室就诊前两周，他服用阿奇霉素水合物1天，磷酸奥司他韦3天，LX-P 5天，以抑制普通感冒症状。第二天，他注意到下唇左侧有糜烂。糜烂3天内自行愈合。三天后，他开始服用LX-P 5天，AMPC 1天，因为他仍然有感冒症状。在此期间，他注意到发烧超过37 ℃，嘴唇和口腔粘膜严重糜烂。因此，他停用所有药物并前往急诊室就诊（第二次皮疹发作后第3天）。急诊室医生怀疑单纯疱疹病毒（HSV）感染，并处方盐酸伐昔洛韦1000 mg/天，持续5天。两天后（第二次爆发后的第5天），他来到我们的部门。在正常体温（36.5 ℃）下，下唇左侧（图1 a）、口腔内粘膜和阴茎头（图1 B）存在深度糜烂。没有临床眼部症状或皮肤损害。他抱怨由于严重的口内疼痛而张口困难。他说他今天早上注意到龟头上有新的糜烂。实验室检查在正常范围内，包括肝功能和肾功能。白色血细胞计数（8800/μl;正常范围，3400 e7300/μl），包括中性粒细胞（6590/μl;正常范围，1214 e5110/μl）和血清C反应蛋白水平（0.79 mg/dl;正常范围，0 e0. 2 mg/dl）略有升高。嗜酸性粒细胞百分比（0.2%;正常0e8%）在正常范围内。梅毒和人类免疫缺陷病毒血清学试验均为阴性。氢氧化钾试验未发现龟头真菌感染。根据他的
Fixed drug eruption (FDE) is a cutaneous adverse drug eruption characterized by skin lesions which recur in the same sites upon reexposure to the drug. 1, 2 It may occur as single or multiple lesions affecting any part of the body, with predilection for the genitalia, hands and lips. 1 Loxoprofen sodium hydrate 3 (LX-P)(Loxonin; Daiichi Sankyo Co., Ltd, Tokyo, Japan) is a nonsteroidal antiinflammatory drug (NSAID) that was approved in Japan in 1986. Amoxicillin hydrate 4 (AMPC)(Sawacillin; Astellas Pharma Inc., Tokyo, Japan) is an antibiotic that was approved in Japan in 1974. Here, we report a case of a 38-year-old man diagnosed with FDE caused by LX-P.A 38-year-old man visited the emergency department in our hospital for diagnosis and treatment of erosions on the lip and intraoral mucosa that had been present for 3 days. Two weeks before his first visit to the emergency department, he had taken azithromycin hydrate for 1 day, oseltamivir phosphate for 3 days, and LX-P for 5 days to suppress the symptoms of common cold. On the following day, he noticed an erosion on the left side of lower lip. The erosion was healed spontaneously in 3 days. Three days later, he started taking LX-P for 5 days and AMPC for 1 day because he still had the symptoms of common cold. During this period, he noticed a fever over 37 C and severe erosions on the lip and intraoral mucosa. Therefore, he stopped all drugs and visited the emergency department (on day 3 after the onset of second eruption). The emergency room doctor suspected herpes simplex virus (HSV) infection and prescribed valacyclovir hydrochloride 1000 mg/day for 5 days. Two days later (on day 5 after the onset of second eruption), he visited our department. Deep erosions were present on the left side of lower lip (Fig. 1 a), intraoral mucosa, and glans penis (Fig. 1 b) with normal body temperature (36.5 C). There were no clinical ocular symptoms or erythematous skin lesions. He complained of difficulty in mouth opening because of the severe intraoral pain. He stated that he noticed new erosions on the glans penis this morning. Laboratory tests were within normal limits, including liver and kidney functions. The white blood cell count (8800/μl; normal range, 3400e7300/μl), including neutrophils (6590/μl; normal range, 1214e5110/μl), and serum levels of C-reactive protein (0.79 mg/dl; normal range, 0e0. 2 mg/dl) were slightly elevated. The eosinophil percentage (0.2%; normal 0e8%) was within normal limits. The negative serological tests for syphilis and human immunodeficiency virus were seen. No fungal infection on the glans penis was identified by a potassium hydroxide test. On the basis of his