中国麻风皮肤病杂志 ›› 2026, Vol. 42 ›› Issue (2): 121-124.doi: 10.12144/zgmfskin202602121

• 病例报告 • 上一篇    下一篇

药物超敏反应综合征合并中毒性表皮坏死松解症一例

吕潇卓1,杨健康2,张晨3,刘芳3,何丽3,王刚3,付萌3   

  1. 1 西安医学院，陕西西安，710021；2 空军第九八六医院皮肤烧伤整形科，陕西西安，710054；3 空军军医大学西京医院皮肤科，陕西西安，710032
  • 出版日期:2026-02-15 发布日期:2026-01-28

Overlapping of drug-induced hypersensitivity syndrome and toxic epidermal necrolysis due to mexiletine : a case report

LYU Xiaozhuo1, YANG Jiankang2, ZHANG Chen3, LIU Fang3, HE Li3, WANG Gang3, FU Meng3   

  1. 1 Xi'an Medical University, Xi'an 710021, China; 2 Skin Burn and Plastic Surgery Department of Air Force 986 Hospital, Xi'an 710054, China; 3 Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
  • Online:2026-02-15 Published:2026-01-28

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摘要： 药物超敏反应综合征（drug-induced hypersensitivity, DiHS）和中毒性表皮坏死松解症（toxic epidermal necrolysis, TEN）被认为是两种类型的严重药物不良反应。本文首次报道美西律致DiHS合并TEN一例。患者，女，46岁，服用盐酸美西律片4周后出现高热、泛发性红色斑丘疹型皮疹、嗜酸性粒细胞百分率明显升高、严重肝功能损害，符合DiHS诊断；随后皮疹迅速进展为全身水疱、大疱，表皮松解面积＞30%体表面积，伴黏膜严重受累，符合TEN表现。患者病情危重、进展迅速，虽经糖皮质激素及重组人Ⅱ肿瘤坏死因子受体-抗体融合蛋白治疗，患者仍出现呼吸停止、自主心率停止。

关键词: 药物超敏反应综合征, 中毒性表皮坏死松解症, 美西律, 嗜酸性粒细胞, 细胞毒T细胞, 肝损害

Abstract: Drug-induced hypersensitivity syndrome (DiHS) and toxic epidermal necrolysis (TEN) are widely recognized as two distinct severe cutaneous adverse drug reactions. This paper reports for the first time a case of DiHS complicate with TEN indused by mexiletine. The patient was a 46-year-old female who developed high fever, generalized maculopapular rash, significantly elevated eosinophil percentage, and severe liver function impairment after taking mexiletine hydrochloride tablets for 4 weeks, meeting the diagnostic criteria for DiHS. Subsequently, her condition progressed rapidly to widespread blisters and bullae with epidermal detachment affecting more than 30% of the body surface area, along with extensive mucosal involvement, consistent with a diagnosis of TEN. The patient had a critical and rapidly progressive clinical course. Despite glucocorticoid and anti-tumor necrosis factor therapy, the patient developed respiratory failure and ultimately experienced cardiac arrest. This case illustrates that DiHS and TEN can sequentially coexist and present overlapping manifestations in clinical practice.

Key words: drug-induced hypersensitivity syndrome, toxic epidermal necrolysis, mexiletine, eosinophils, cytotoxic T lymphocytes, hepatic injury