史蒂芬—強森症候群 (Steven–Johnson syndrome, SJS) 與毒性表皮溶解 (toxic epidermal necrolysis, TEN) 是眾所周知的嚴重黏膜皮膚不良反應，屬於第四型之過敏反應，其特點是發生率低但死亡率高，最常見的原因是由藥物引起約占85%。全世界TEN 每年的發生率為每一百萬人中有0.4 ~ 1.3 個案，屬極為罕見。2019 年最新研究分析1998 年 ~ 2017 年在亞洲國家與SJS/TEN 相關藥物中，imipenem 只有2 個案例被報導過。本文敘述1 位肺炎的病患因胸膜液細菌培養出大腸桿菌 (Escherichia coli) 使用imipenem-cilastatin (Tienam®) 後產生TEN 之嚴重藥物不良反應，進一步以SCORTEN (A Severity-of-Illness Score for Toxic Epidermal Necrolysis) 疾病嚴重程度評分系統評估，本案例評估結果為5 分，死亡率為90%。個案在停用藥物及採取相關治療後狀況持續惡化，最後因敗血症導致多重器官衰竭死亡，後續病患家屬進行藥害救濟申請。本文提供醫師、藥師及護理人員在給予藥物治療期間應隨時留意病患狀況並評估危險因子，確保病患之用藥安全。
Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), known as severe mucocutaneous adverse reactions, are type IV allergic reactions. They are characterized as low incidence diseases with high mortality rates. Approximately 85% of SJS and TEN cases are drug-induced. The annual incidence of TEN ranges from 0.4 to 1.3 cases per million people per year, which is extremely rare in the world. A metaanalysis that was conducted in 2019 investigated the SJS/TEN related drugs from 1998 to 2017 in Asian countries. Only 2 SJS/TEN cases were reported as imipenem induced adverse drug reactions. This current report describes a patient diagnosed with pneumonia with Escherichia coli in the pleural fluid. Severe adverse drug reactions, referred to SJS/TEN, occurred after using imipenem-cilastatin (Tienam®). This case was further evaluated by the SCORTEN (A Severity-of-Illness Score for Toxic Epidermal Necrolysis), a disease severity score system. The evaluation results showed a score of 5 points and approximately 90% of the mortality rate. After stopping the drug and giving relief medications, the patient’s condition continued to worsen and finally expired from sepsis and multiple organ failure. The patient’s family applied for drug injury relief. Physicians, pharmacists, and nursing staff should pay more attention to a patient’s condition and evaluate the risk factors at all times during drug treatment to ensure medication safety.
Summited for publication: 2020.6.10; Accepted for publication: 2020.9.9
