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首页> 外文期刊>Clinical and Translational Allergy >A severe cutaneous reaction caused by acetaminophen in a pediatric patient
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A severe cutaneous reaction caused by acetaminophen in a pediatric patient

机译：对乙酰氨基酚引起的严重皮肤反应

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A small girl of 2 years-6-months was admitted to ourhospital for widespread rash on the face, trunk andlimbs that had begun 24 hours previously; she alsocomplained arthralgia of small and large joints andfever. She had received acetaminophen at home for3 days because of febrile gastroenteritis. Family historywas positive for allergy (mother had allergic rhinitis andbeta-lactam drug allergy). The rash was widespread andincluded confluent purpuric macules on the trunk, limbsand on the face. There was no mucosal involvement andno skin detachment. Blood work up showed a slightincrease of CRP (1.1 mg/dl) and ESR (34 mm/1h), as wellas elevated tryptase (19.2 ng/ml – nv 0-5) and total IgE(178 KU/I). Liver and kidney function was normal as wellas electrolytes and coagulation; screening for autoimmunity(ANA, ENA, AMA, antiDNA, ASMA, ANCA, C3,C4, rheumatoid factor) and the infectious valutation (Abanti CMV, EBV, HHV6 and 8, Mycoplasma, postnasalswab for virus) were negative. Skin biopsy was compatiblewith vasculitis from possible adverse drug reaction (slightoedema in the upper dermis associated with perivascularlymphohistiocytic infiltrate, without a relevant presence ofeosinophils). The patient was treated with methylprednisolonewith rapid alleviation of symptoms and a completeresolution within 10 days. The pediatric literature reportsnumerous hypersensitivity reactions with vascular involvement,caused by NSAIDs and beta-lactam agents (1), whilecases regarding the assumption of acetaminophen are rare.Although adverse cutaneous reactions to acetaminophenare rare, considering the widespread use of this drug inpediatric age, we believe that the description of this case isuseful inasmuch as a prompt diagnosis and an early treatmentas well as drug suspension are crucial for improvingthe prognosis.
机译：2岁零6个月的小女孩因24小时前开始出现的面部，躯干和四肢广泛皮疹而入院。她还对小关节和大关节发烧和发热的关节痛进行了治疗。由于发热性肠胃炎，她在家中接受了对乙酰氨基酚治疗3天。家族史为过敏阳性（母亲患有过敏性鼻炎和β-内酰胺类药物过敏）。皮疹广泛存在，包括躯干，四肢和面部汇合的紫癜性黄斑。没有粘膜受累，也没有皮肤脱离。血液检查显示CRP（1.1 mg / dl）和ESR（34 mm / 1h）略有增加，而类胰蛋白酶（19.2 ng / ml – nv 0-5）和总IgE（178 KU / I）略有增加。肝肾功能正常，电解质和凝血功能正常。自身免疫性筛查（ANA，ENA，AMA，抗DNA，ASMA，ANCA，C3，C4，类风湿因子）和传染性评估（Abanti CMV，EBV，HHV6和8，支原体，鼻咽拭子）。皮肤活检与可能引起药物不良反应的血管炎相容（与周围血管淋巴组织细胞浸润相关的上层真皮轻度水肿，无嗜酸性粒细胞的相关存在）。该患者接受了甲泼尼龙治疗，症状迅速缓解，在10天内完全缓解。儿科文献报道了由NSAIDs和β-内酰胺类药物引起的许多血管侵犯性超敏反应（1），而对乙酰氨基酚的假设病例很少见，尽管考虑到该药物在儿童年龄的广泛使用，对乙酰氨基酚的不良皮肤反应很少见。认为该病例的描述是有用的，因为及时诊断和及早治疗以及药物混悬对于改善预后至关重要。

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