摘要
1例25岁女性患者确诊类风湿关节炎后给予泼尼松、来氟米特、羟氯喹和碳酸钙维生素D等药物治疗，病情控制良好。因有生育要求，调整治疗方案为口服柳氮磺吡啶1.0 g、2次/d及羟氯喹0.2 g、2次/d。约2个月后患者出现发热、咽痛，双侧扁桃体Ⅱ度肿大、表面有脓性渗出物，双侧颈部淋巴结肿大，实验室检查示白细胞计数（WBC） 0.6×109/L，中性粒细胞计数0.01×109/L。考虑为柳氮磺吡啶所致中性粒细胞缺乏症，并发急性化脓性扁桃体炎。停用柳氮磺吡啶和羟氯喹，给予重组人粒细胞集落刺激因子150 μg 皮下注射，1次/d，连续6 d，同时进行抗感染及对症支持治疗。3周后患者WBC及中性粒细胞计数恢复正常，临床症状消失。再次给予羟氯喹和碳酸钙维生素D口服。随访6个月，患者血常规检查结果正常，类风湿关节炎病情稳定。
A 25-year-old woman with rheumatoid arthritis was treated with prednisone, leflunomide, hydroxychloroquine, and calcium carbonate vitamin D. Her condition was controlled well. Because of her fertility requirement, the therapeutic regimen was changed to sulfasalazine 1.0 g and hydroxychloroquine 0.2 g twice daily orally. About 2 months later, the patient developed fever, sore throat, swelling of bilateral tonsils （degreeⅡ） with purulent exudates on the surface, and bilateral cervical lymph nodes swelling. Laboratory tests showed white blood cell count 0.6×109/L and neutrophil count 0.01×109/L. The patient was diagnosed as having agranulocytosis induced by sulfasalazine accompanied by acute suppurative tonsillitis. Sulfasalazine and hydroxychloroquine were stopped and subcutaneous injection of recombinant human granulocyte colony stimulating factor 150 μg once daily were given for 6 consecutive days. Meanwhile, anti-infectious and symptomatic support treatments were given. Three weeks later, her white blood cell count and neutrophil count were returned to normal, and the clinical symptoms disappeared. Hydroxychloroquine and calcium carbonate vitamin D were given again. At 6 months of follow-up, the blood routine test results were normal and the condition of rheumatoid arthritis was stable.
作者
赵义
黄旭
廖秋菊
田真
李雪梅
李小霞
Zhao Yi;Huang Xu;Liao Qiuju;Tian Zhen;Li Xuemei;Li Xiaoxia(Department of Rheumatology and Immunology,Xuanwu Hospital,Capital Medical University,Beifing 100053,China)
出处
《药物不良反应杂志》
CSCD
2018年第5期380-381,共2页
Adverse Drug Reactions Journal
