毒性表皮溶解症是臨床上嚴重且危及生命的皮膚黏膜疾病，主要是由藥物所引起的延遲性過敏反應。Esomeprazole 具有良好的安全性與耐受性，長期使用可能出現臨床少見的不良事件，包括低血鎂症、骨質疏鬆骨折與困難梭狀芽孢桿菌感染等。Esomeprazole 引起的毒性表皮溶解症為罕見且嚴重的皮膚不良反應，根據文獻搜尋指出，目前僅有數篇案例報告與一篇病例系列研究之文獻發表。本文探討一位89 歲男性，有高血壓、高尿酸血症、慢性阻塞性肺病、慢性腎臟病與攝護腺癌病史，因為胃痛使用esomeprazole，於服藥後第19 天，皮膚出現紅紫色斑塊病灶且伴隨有疼痛感；一週後因發燒與皮膚紅紫色斑塊病灶至急診就醫住院，病人的臉部、軀幹與四肢之紅紫色斑塊出現水泡；於服藥後第30 天停止使用esomeprazole。因合併有代謝性酸中毒與敗血症且全身皮膚傷口面積達63% 至70%，醫師診斷為毒性表皮溶解症，將病人轉至燙傷加護病房，並處方etanercept 治療，但因病況持續惡化而死亡。臨床醫療人員對於esomeprazole 造成的毒性表皮溶解症必須提高警覺，及時判別出不良反應藥物並盡早停用，才能進一步降低病人的死亡風險。

 

Toxic epidermal necrolysis is a severe and life-threatening mucocutaneous disease. It is a delayed- type hypersensitivity reaction primarily caused by medication. Esomeprazole is well safe and tolerated. Rare adverse events with long-term using esomeprazole include hypomagnesemia, osteoporotic fracture, Clostridium difficile infection, etc. Esomeprazole induced toxic epidermal necrolysis is a rare and severe cutaneous adverse reaction. After searching the literature, we found that there were only few case reports and one case-series study. We reported the case of an 89-yearold man with past history of hypertension, hyperuricemia, chronic obstructive pulmonary disease, chronic renal disease, and prostate cancer. Esomeprazole was prescribed because of the stomach pain. Nineteen days after esomeprazole was prescribed, the skin sign of painful erythematous lesions with central violaceous change was noted. After one week, he went to the emergency room because of fever and erythematous lesions with central violaceous change. Then he was hospitalized. Violaceous patch with bullae was noted on his face, trunk, and extremities. Thirty days after esomeprazole was started, the prescription of esomeprazole was discontinued. Combination with metabolic acidosis, sepsis and skin detachment of 63–70 percent of body surface area, toxic epidermal necrolysis was diagnosed. Patient was transferred to burn intensive care unit. Etanercept was prescribed. The condition of disease was getting worse, and then he died. Clinicians must be aware of the toxic epidermal necrolysis caused by esomeprazole. Early identification and cessation of the culprit drugs can help to reduce the risk of mortality.

 

Submitted for publication: 2022.7.8; Accepted for publication: 2022.9.5