Druginduced hypersenstivity syndrome课件.ppt

模板来自于 * Drug-induced hypersensitivity syndrome (DIHS) HISTORY Drug-Induced Hypersensitivity Syndrome (DIHS), was first recognized in 1950 by Chaiken, in a patient using anticonvulsant. Later,SaItzstein described this kind of drug reaction as pseudo lymphoma In the 1960s with the development of carbamazepine, the disease named antispasmodic syndrome in addition to anticonvulsants,diaphenylsulfone(DDS). allopurinol(别嘌醇),salazosulfapyridine(柳氮磺胺吡啶) and dapsone(氨苯砜) can also cause DIHS Defition Drug-Induced Hypersensitivity Syndrome (DIHS) is a severe and rare systemic reaction triggered by a drug (usually an antiepileptic drug). accompanied by fever, lymphadenopathy, hepatitis, hematologic abnormalities with eosinophilia and atypical lymphocytes, and may involve other organs with eosinophilic infiltration, causing damage to several systems, especially to the kidneys, heart, lungs, and pancreas is characterized by late onset, infectious mononucleosis-like symptoms, and herpesvirus 6 (HHV-6) reactivation. Etiopathogenesis Drug:deficiency or abnormality of the epoxide hydroxylase enzyme(环氧酶羟化酶) that detoxifies the metabolites of aromaticamine anticonvulsants (metabolic pathway) Herpesvirus:associated sequential reactivation of herpesvirus family.(Recently,accumulating evidence suggests that other HHVs, such as HSV, EBV, HHV-7 and CMV might be reactivated during the course of DIHS) Gene:NAT2 and certain human leukocyte antigen (HLA) alleles (immune response) Clinical manifestations incubation period(2-6weeks) Fever,：often high (38.5-40oC) Rash:Maculopapular rash developing＞ 3 weeks after starting therapy with a limited number of drugs.The cutaneous eruption consists of a morbilliform rash, which is also common in other less severe drug reactions and both presentations are indistinguishable The face, upper trunk and upper extremities are initially affected, with subsequent progression to the lower extremities. Lymphadenopathy (2mm) The maculopapular eruption later becomes