輔助營養治療應用對藥物誘發史蒂芬強森症候群／毒性表皮溶解症併發敗血症：個案報告

Adjuvant Nutritional Therapy for Drug-Induced Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Complicated by Methicillin-Resistant Staphylococcus aureus Sepsis: A Case Report

一名43歲女性因使用Ibuprofen而誘發史蒂芬強森症候群/毒性表皮溶解症(Stevens-Johnson syndrome/toxic epidermal necrolysis, SJS/TEN)併發抗甲氧苯青黴素金黃色葡萄球菌(methicillin-resistant Staphylococcus aureus, MRSA)敗血症。入住本院加護病房後，患者接受輔助營養治療以對抗急性高度發炎性溶解水皰症、MRSA敗血症及高乳酸血症，包括攝取適當的熱量、蛋白質、微量營養素等。當患者被診斷出嚴重維生素D缺乏症時，立即於24小時內補充維生素D3 57.6萬國際單位。於住院期間，患者無發生嚴重再餵食症候群、高血鈣、或急性腎衰竭等併發症。接受12天的輔助營養治療，患者的皮膚癒合後，即離開加護病房。輔助營養治療或許對於SJS/TEN併發MRSA敗血症及高乳酸血症的患者具有效益性。

A 43-year-old woman presented with ibuprofen-induced Stevens-Johnson syndrome/ toxic epidermal necrolysis (SJS/TEN) complicated by methicillin-resistant Staphylococcus aureus (MRSA) sepsis. She was admitted to our intensive care unit (ICU) and started on adjuvant nutritional therapy involving adequate calorie, protein, and micronutrient intake for acute hyperinflammatory vesiculobullous reactions, MRSA sepsis, and hyperlactatemia. Upon being diagnosed with severe vitamin D deficiency, she received vitamin D3 576,000 IU within 24 hours. Severe refeeding syndrome, hypercalcemia, and acute kidney injury did not occur during hospitalization. After 12 days of adjuvant nutritional therapy, her skin had healed and she was discharged from the ICU. Adjuvant nutritional therapy may be beneficial for patients with SJS/TEN complicated by MRSA sepsis and hyperlactatemia.