Nephrotoxicity and Purpura Associated with Levofloxacin
Nephrotoxicity and Purpura Associated with Levofloxacin
复制标题
与左氧氟沙星相关的肾毒性和紫癜
DOI：
10.1345/aph.1a474
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发表时间：
2002
期刊：
影响因子：
--
通讯作者：
C. De Simone
中科院分区：
文献类型：
--
作者：
G. Famularo;C. De Simone
目的：报道1例接受左氧氟沙星治疗的肺癌合并特发性骨髓纤维化伴髓系化生的患者发生紫癜和急性肾功能衰竭，并对现有的喹诺酮类药物肾毒性文献进行综述。病例摘要：一位73岁的白人男性，有非小细胞肺癌和特发性骨髓纤维化伴髓系化生的病史，因下尿路感染而开出左氧氟沙星。三天后，他出现了明显的紫癜和下肢和躯干的红斑性皮肤病变，尿量明显减少。血肌酐为6.4 mg/dL，尿素氮为190 mg/dL。停用左氧氟沙星，给予泼尼松、速尿和静脉输液。患者在接下来的4周内完全康复。结论：左氧氟沙星引起的肾毒性并不常见。过敏性间质性肾炎或血管炎被认为是潜在的病理过程。确诊需要进行肾活检，尽管这并不总是可行的。在这种情况下，肾功能恢复正常，停用左氧氟沙星和皮质类固醇治疗后紫癜消失，支持对左氧氟沙星过敏反应的推定诊断。
OBJECTIVE: To report a patient with lung cancer and idiopathic myelofibrosis with myeloid metaplasia who developed purpura and acute renal failure while receiving levofloxacin, and review the existing literature on quinolone nephrotoxicity. CASE SUMMARY: A 73-year-old white man, with a medical history of non-small-cell lung cancer and idiopathic myelofibrosis with myeloid metaplasia, was prescribed levofloxacin because of a lower urinary tract infection. Three days later, he presented with palpable purpura and erythematous skin lesions over the lower limbs and trunk, with a markedly reduced urinary output. Serum creatinine and urea nitrogen were 6.4 and 190 mg/dL, respectively. Levofloxacin was discontinued, and prednisone, furosemide, and intravenous fluids were given. The patient fully recovered over the ensuing 4 weeks. CONCLUSIONS: Nephrotoxicity associated with levofloxacin is uncommon. Allergic interstitial nephritis or vasculitis is believed to be the underlying pathologic process. Definitive diagnosis requires performance of renal biopsy, although this is not always feasible. In this case, a return of renal function to normal, with the disappearance of purpura following the discontinuation of levofloxacin and corticosteroid treatment, supports the presumptive diagnosis of a hypersensitivity reaction to levofloxacin.