毒性表皮溶解症之臨床案例報告

Toxic Epidermal Necrolysis: A Case Report

毒性表皮溶解症（Toxic epidermal necrolysis, TEN）由Alan Lyell於1956所提出，故又稱為Lyell syndrome，是罕見但有高致死率的疾病，常由藥物的不良反應所引起。在臺灣，常見的致病藥物包括：抗癲癇藥物、抗生素、降尿酸藥物與非類固醇抗發炎藥物。此案例為一位36歲男性因頸椎第七節處脊髓血管性病灶併長節段出血性病變，接受頸椎手術，術前使用Ampicillin （Ampolin®）及Acetaminophen（Depyretin®）等非特異性的處方藥物，在術後7天產生發燒、皮膚疹、麻疹樣疹和大水疱，經鑑別診斷確診為毒性表皮溶解症。由於目前尚不知TEN真正的致病機轉與缺乏標準化的治療流程，應儘早停用致病藥物及適當地給予支持性照護，此次過敏史應於病歷中特別註記及避免再次接觸引起過敏的藥物、教育病人及家屬認識導致病人過敏反應的藥物等，為預防日後併發症再發生之策略，提醒醫護同仁觀察病人對藥品不良反應並保持警覺是一個相當重要的課題。

Toxic epidermal necrolysis (TEN) was first reported by Alan Lyell in 1956 and was named as the Ly-ell syndrome. TEN occurs rarely due to a serious adverse drug reaction but with a high mortality rate. The common offending agents include anticonvulsants, antibiotics, allopurinol, and non-steroidal an-ti-inflammatory drugs in Taiwan. The case in this report was a 36-year-old male patient, who received surgery of C7 spinal vascular lesions and long segmental hemorrhagic lesions (from C1 to T1 levels). He was prescribed Ampicillin (Ampolin®) and acetaminophen (Depyretin®) prior to surgery. The patient got a fever, skin eruption, morbilliform rash and bullas during the seven days of the postoperative period. Finally, he was identified to get toxic epidermal necrolysis by the differential diagnosis. The pathogenic mechanisms of TEN are still unclear and the standardized treatment procedures of it are also lacking. The suspected TEN-induced drugs should be discontinued as soon as possible and the patient needs to be appropriately provided with the supportive care. The ways to prevent the com-plications from occurring again in the future include taking notes of the drug allergy history on the medical records to avoid contacting with the allergenic drugs again, and offering the patients and their family the knowledge relates to allergic reactions-induced drugs. Moreover, it is important to remind medical staffs that keeping alarm and observing the adverse drug reactions for patients.