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J Int Med Res ; 48(5): 300060520922416, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32400243

RESUMO

A 56-year-old man diagnosed with non-Hodgkin's lymphoma underwent autologous bone marrow transplantation. He was subsequently admitted to the hospital with fever, and his symptoms were initially controlled by multiple antibiotics, including tigecycline. He then developed a generalized body rash that improved after treatment with anti-allergy drugs and steroids. Furthermore, tigecycline treatment for a second time resulted in a severe skin reaction with systemic symptoms, suggesting toxic epidermal necrolysis syndrome (TEN). The patient was shown to have the slow-metabolizing cytochrome P450 2C19 allele, denoted CYP2C19*2. He was transferred to a laminar flow ward and given strict mucosal care, together with corticosteroids and intravenous immunoglobulin. He recovered after 3 weeks of treatment. Tigecycline-induced Stevens-Johnson syndrome (SJS)/TEN has rarely been reported in the Chinese population. However, our experience suggests that Asians are more likely to have adverse reactions to drugs metabolized by the cytochrome P450 enzyme. Early identification of drug reactions and immediate cessation of the suspected drug is essential. Additionally, a combined therapy scheme and a clean laminar flow environment may improve the cure rate of SJS/TEN.


Assuntos
Infecções Bacterianas/tratamento farmacológico , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Síndrome de Stevens-Johnson/etiologia , Tigeciclina/efeitos adversos , Alelos , Infecções Bacterianas/imunologia , Biópsia , Citocromo P-450 CYP2C19/genética , Citocromo P-450 CYP2C19/metabolismo , Glucocorticoides/administração & dosagem , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Linfoma Difuso de Grandes Células B/imunologia , Linfoma Difuso de Grandes Células B/terapia , Masculino , Pessoa de Meia-Idade , Pele/efeitos dos fármacos , Pele/patologia , Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/tratamento farmacológico , Síndrome de Stevens-Johnson/patologia , Tigeciclina/farmacocinética , Transplante Autólogo/efeitos adversos , Resultado do Tratamento
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