Druginduced hypersensitivitysyndrome 课件.ppt

学习 1.激素 甲强龙：10mg/Kg*d *3d,减量为5mg/Kg*d *4， 2.5mg/Kg*d *2d 2.血浆置换：10.15、10.17进行2次 3.免疫球蛋白：10.14 IVIG：12.5mg 10.15 IVIG：17.5mg 经过上述治疗，现患儿无发热、皮疹已退。复查肝功：ALT：167、AST：118。肝肋下8cm，剑突下8.5cm。血常规：WBC：31.07，L：0.5，N：0.4，嗜酸：0.08，HB：90。肺部病变较前有所吸收、心肌标志物阴性 谢 谢 大 家 模板来自于 * Drug-induced hypersensitivity syndrome (DIHS) HISTORY Drug-Induced Hypersensitivity Syndrome (DIHS), was first recognized in 1950 by Chaiken, in a patient using anticonvulsant. Later,SaItzstein described this kind of drug reaction as pseudo lymphoma In the 1960s with the development of carbamazepine, the disease named antispasmodic syndrome in addition to anticonvulsants,diaphenylsulfone(DDS). allopurinol(别嘌醇),salazosulfapyridine(柳氮磺胺吡啶) and dapsone(氨苯砜) can also cause DIHS Defition Drug-Induced Hypersensitivity Syndrome (DIHS) is a severe and rare systemic reaction triggered by a drug (usually an antiepileptic drug). accompanied by fever, lymphadenopathy, hepatitis, hematologic abnormalities with eosinophilia and atypical lymphocytes, and may involve other organs with eosinophilic infiltration, causing damage to several systems, especially to the kidneys, heart, lungs, and pancreas is characterized by late onset, infectious mononucleosis-like symptoms, and herpesvirus 6 (HHV-6) reactivation. Etiopathogenesis Drug:deficiency or abnormality of the epoxide hydroxylase enzyme(环氧酶羟化酶) that detoxifies the metabolites of aromaticamine anticonvulsants (metabolic pathway) Herpesvirus:associated sequential reactivation of herpesvirus family.(Recently,accumulating evidence suggests that other HHVs, such as HSV, EBV, HHV-7 and CMV might be reactivated during the course of DIHS) Gene:NAT2 and certain human leukocyte antigen (HLA) alleles (immune response) Clinical manifestations incubation period(2-6weeks) Fever,：often high (38.5-40oC) Rash:Maculopapular rash developing＞ 3 weeks after starting therapy with a limited number of drugs.The cutaneous eruption consists of a morbilliform rash, which is also