克流感相關之失去現實、自我感

Oseltamivir-related Derealization and Depersonalization Experiences

目的：本曾報告多起兒童流感個案，使用克流感後出現神經精神症狀，甚至有致死危險。但克流感與神經精神症狀之相關性及機轉仍未釐清。病例報告：一位有注意力缺失過動的十三歲台灣男孩在出現流感症狀經篩檢為甲型流感後開始克流感治療。服藥一天後病人出現失去現實及自我感之症狀。症狀在停用克流感五天後逐漸消失。結論：流感病人服用克流感後罕有失去現實、自我感的症狀。此個案以Naranjoscale評估，其神經精神症狀「可能」由克流感引起。克流感相關神經精神症狀之高異質性、致病機轉、及辨識高風險病人之方法值得更進一步的研究。

Background: Neuropsychiatric events have been reported in novel infl uenza A (H1N1) patients treated with oseltamivir, especially in pediatric population, and mostly in Japan. Some of these events may have lethal consequences. Case Report: A 13-year-old boy with attention-defi cit/hyperactivity disorder had novel infl uenza A (H1N1) infection and received oseltamivir treatment. He developed depersonalization and derealization experiences soon after oseltamivir use, which led to functional impairment that persisted for around 10 days. The experiences lasted fi ve days after his stopping of oseltamivir and recovering from the infection. The patient returned to his baseline subsequently. Conclusion: Depersonalization and derealization are uncommon neuropsychiatric manifestations occurred after taking oseltamivir medication in patients with infl uenza infection. A possible causal relationship according to the Naranjo probability scale was observed. The varied neuropsychiatric adverse events, unclear pathological mechanism, and the approach to identify patients in a high-risk population necessitate further investigation.