Before discharge, medical staff instruct the patient's family to take medication.
When: November 13.
Location: Zhongshan Hospital, Xiamen University.
Self-medication without standardized diagnosis and treatment may lead to serious consequences. Recently, a Quanzhou grandmother suffered from severe drug eruption caused by improper medication, and her whole body was eroded, and she was critically ill for a time.
Erosion all over the body. Grandma was admitted to the hospital and was critically ill.
On the evening of November 13, a mentally depressed Quanzhou grandmother, accompanied by her son, went to the emergency department of Zhongshan Hospital affiliated to Xiamen University. This situation is relatively rare, and the waiting crowd is looking sideways.
The emergency department immediately called for multidisciplinary consultation such as ** department, respiratory and critical care medicine, vascular surgery, and hematology, and initially considered toxic epidermal necrolysis (TEN) caused by drug allergy, which is a severe drug eruption with a mortality rate of up to 30%-35%.
* Xu Yanzhu, the doctor on duty in the department, recalled that the grandmother could not eat, she was weak when she opened her eyes, and there were typical severe erythema multiforme and blisters distributed in many parts of her body, and the area of epidermal release of the whole body was 30%, of which there was a large blood blister of about 10 cm in the palm of the hand and the bottom of the foot, and there were obvious erosive ulcers on the conjunctiva and lips. According to the family, the grandmother had a fever for 3 days at that time, and it was ineffective to reduce fever and anti-infection in the local hospital.
The patients and their families were shocked to learn that this ** disease could be fatal. After being hospitalized, the doctor suspended the use of all drugs that could cause allergies and issued a critical illness notice.
Peeling back the cocoon, the doctor tracks down the "culprit".
To address toxic epidermal necrolysis, it is important to identify as soon as possible which drug is causing the allergy. However, Grandma's past medical history is complicated, including pulmonary embolism, chronic pulmonary hypertension, gout, respiratory failure, heart failure, hypertension, etc., and there are seven or eight kinds of daily medications.
Some antipyretics and anti-inflammatory drugs can cause drug rashes. Wang Zhiqiang, the doctor in charge of the bed, asked the family to bring the drugs commonly used by the grandmother to the hospital as soon as possible, and asked and examined them one by one. At this time, a box of allopurinol that had not been eaten caught the doctor's attention - it is more allergenic than diclofenac sodium, causing more cases of severe drug eruptions. Dr. Wang immediately asked about the start time of taking the medicine, and the family said that the grandmother had worsened her gout about a week ago, and she heard from her neighbor that allopurinol ** gout had a good effect, so she bought allopurinol to take it by herself.
The laboratory department of Zhongshan Hospital immediately conducted a pharmacogenetic test for her grandmother, and the result was positive. Director Jiang Xiaoyong, the leader of the science department, pointed out that this test is very critical, and accurately finding the "culprit" has an important guiding role in the next ** and the continuous safe use of drugs by grandma.
Multidisciplinary assistance
Grandma "molts and is reborn".
Find out the "culprit", and the next step is precision treatment.
For patients with severe drug eruption, the traditional approach is usually systemic glucocorticoids or a combination of human immunoglobulin. Director Jiang Xiaoyong took into account that although this kind of hormone can significantly reduce the mortality rate, the grandmother is old, the underlying diseases are complex, the adverse effects of long-term use of high-dose hormones are large, and human immunoglobulin is expensive. After much deliberation, he chose to use adalimumab, a low-cost TNF-inhibitor. **During this period, Grandma needed to change the dressing frequently to prevent infection due to erosion all over the body, and two doctors were required to go into battle each time the dressing was changed, and one stop was 2 hours. Doctors from the Department of Respiratory and Critical Care Medicine, Hematology, and Infectious Diseases have also consulted many times to comprehensively deal with various conditions, and multidisciplinary cooperation has helped them overcome the "life and death barrier". After more than 3 weeks**, the almost "incomplete" grandmother finally regained her life and grew new ** all over her body.
Considering the genetic predisposition to allopurinol allergy, the doctor repeatedly told Grandma's close relatives not to take this medicine casually.
Doctor's Notes. There is no standardized diagnosis and treatment.
Do not self-medicate.
Jiang Xiaoyong, leader of the science department of Zhongshan Hospital affiliated to Xiamen University:
Toxic epidermal necrolysis (TEN) is a rare, explosive exfoliation of the epidermis and mucous membranes, characterized by blisters and generalized epidermolysis, which can be accompanied by multi-system involvement, and is one of the most severe diseases in the industry, with a high mortality rate.
To prevent drug rash, we must first standardize medical treatment and strengthen the awareness of safe drug use. If you have a clear allergy to a drug, you should record the allergenic drug in your medical record and keep it in mind, and provide your doctor with a history of allergies before taking the drug. Certain human leukocyte antigen (HLA) alleles are closely linked to the development of drug eruptions, and it is best to test for allopurinol, carbamazepine, and oxcarbazepine if drugs are needed. For example, allopurinol, the diagnosis and treatment routine of our hospital requires HLA gene screening first, and the test result is negative before it can be administered.
Mild drug eruptions can resolve after timely drug withdrawal, while severe drug eruptions may cause multiple organ failure and life-threatening if not prompted. It is especially reminded that medication should be taken under the guidance of a doctor and not self-medication. If there is discomfort such as erythema, pimples, itching and other discomforts after taking the drug, the suspicious drug should be stopped immediately, closely observed and treated in time.
Text: Xiamen** reporter Chu Yan, correspondent Zhang Shushan, Chen Binglin).