社團法人臺灣臨床藥學會

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【案例報告】病例報告:疑似levothyroxine引起之藥物熱
Case Report: R/O Levothyroxine Induce Drug Fever
藥物熱、發燒曲線圖、不明熱、drug fever, fever curve, fever of unknown origin
何志豪Chi-Hou Ho1 、曾綉惠Hsiu-Hui Tseng*2 、田月玄Yueh-Hsuan Tien3 、陳麗芳Agnes L.F. Chan4
1財團法人奇美醫院藥劑部 、2高雄醫學大學附設中和紀念醫院藥劑科 、3美和技術學院護理系 、4財團法人奇美醫院藥劑部
    藥物熱為臨床上常發生之藥物不良反應,主要於使用藥物後直接或間接引起的發熱。藥物熱雖常見於臨床上但其鑒別診斷卻並不容易,必須排除其他可能引起發熱之原因,且把疑似藥物停藥後,才能進一步確認為藥物熱。由於目前並沒制定出可供直接診斷的檢驗方法及規範。故此常造成誤診誤治之情形,若不能及時停用致熱藥物更可能危及生命。特此提出此一病例報告,以提高醫療同仁之警覺。
    患者為一名 81 歲的男性,此次因跌倒失去意識而至本院急診就醫治療,住院診斷為顱內出血,經由顱骨切開手術順利清除出血,但由於呼吸衰竭故於氣切後轉入呼吸加護病房,住院期間一直持續發燒,最後經排除其他可能原因後疑似為藥物熱,並把可能引起藥物熱之甲狀腺素作劑量調整後,則病患之體溫回復至正常。並且順利脫離呼吸器,轉至普通病房後病情穩定出院。

    Drug fever is a adverse drug reaction commonly found in clinical cases. It is mainly caused by the direct or indirect taking in of medicines for fever. Though it is frequently seen in clinical cases, drug fever is hard to be examined. It is a must to eliminate any other causes that may lead to a fever, stop taking in related medicines and thus to ascertain that this is a drug fever. Up till now, there is no direct examination method and norm for a proper diagnosis. Therefore, this leads to a wrong judgment. If it is impossible to stop the taking of medicines for drug fever, life can be endangered. Hereby, this case report is presented to raise the awareness of all fellow colleagues. 
    The patient was an eighty-one year-old male. He was fallen down accidentally and thus was admitted to hospital. It had been diagnosed that he had intracranial hemorrhage and Craniotomy was done to remove all blood. Due to respiratory failure, he was transmitted to the Respiratory Care Center after Tracheostomy. He had sustained fever while staying in the hospital, and was finally diagnosed as having drug fever after eliminating all other possible causes. The patient’s body temperature returned to normal level after adjusting the dosage of levothyroxine. He had been weaned of mechanical ventilator, transferred to the ward and was discharged from the hospital then.
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