Stevens-Johnson症候群および中毒性表皮壊死症の治療と予後に関する検討 : 横浜市立大学附属2病院における46例の検討  [in Japanese] ANALYSIS OF TREATMENTS AND DECEADED CASES OF SEVERE ADVERSE DRUG REACTIONS : ANALYSIS OF 46 CASES OF STEVENS-JOHNSON SYNDROME AND TOXIC EPIDERMAL NECROLYSIS  [in Japanese]

Access this Article

Author(s)

    • 山根 裕美子 Yamane Yumiko
    • 横浜市立大学大学院環境免疫病態皮膚科学 Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine
    • 相原 道子 Aihara Michiko
    • 横浜市立大学大学院環境免疫病態皮膚科学 Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine
    • 立脇 聡子 [他] Tatewaki Satoko
    • 横浜市立大学大学院環境免疫病態皮膚科学 Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine
    • 蒲原 毅 Kanbara Takeshi
    • 横浜市立大学附属市民総合医療センター皮膚科 Department of dermatology, Yokohama City University Medical Center
    • 山川 有子 Yamakawa Yuko
    • 横浜市立大学附属市民総合医療センター皮膚科 Department of dermatology, Yokohama City University Medical Center
    • 池澤 善郎 Ikezawa Zenro
    • 横浜市立大学大学院環境免疫病態皮膚科学 Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine

Abstract

【背景】Stevens-Johnson syndrome(SJS)およびtoxic epidermal necrolysis(TEN)の治療としてはステロイド薬の全身投与のほか,免疫グロブリン大量療法や血漿交換療法が試みられている.【目的】SJSおよびTENの治療の現状とその効果を評価する.【方法】2000年から2007年の8年間に横浜市立大学附属2病院皮膚科で経験したSJS 27例とTEN 19例についてその臨床的特徴および治療法を検討した.【結果】TENの1例を除き全例でステロイド薬の全身投与が行われていた.ステロイドパルス療法が選択された症例はSJSの8例,TENの9例であり,免疫グロブリン大量療法や血漿交換療法が併用された症例はSJSで3例,TENで8例あった.死亡率はSJSが3.7%(1例),TENが21.1%(4例)であった.TENの死亡例2例は敗血症を合併し死亡した.【結語】感染症管理の難しさが浮き彫りとなったが,適切なステロイド薬の投与はSJSおよびTENに有効な治療法であると考えられた.

Background: Systemic administration of corticosteroid, plasmapheresis and high-dose immunoglobulin therapy (IVIG) are the main treatment of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Objective: To evaluate the effects of the treatments of SJS and TEN. Methods: Twenty-seven cases of SJS and 19 cases of TEN treated in our hospitals from 2000 to 2007 were analyzed. Results: Corticosteroid was administered systemically in all cases except one case of TEN which developed methicillin resistant staphylococcus aureus (MRSA) pneumoniae before the onset of the eruption. Methylprednisolone (mPSL) pulse therapy (1000mg/day) or mini pulse therapy (less than 600mg/day of mPSL) was selected by 8 cases of SJS and 9 cases of TEN. Combination of plasmapheresis or IVIG with corticosteroid therapy was performed in 3 cases of SJS and 8 cases of TEN. The mortality rate of patient with SJS was 3.7% (1 case), and with TEN was 21.1% (4 cases). The deceased case of SJS had been treated with corticosteroid alone and died for acute respiratory disorder after 24 days from the onset of the eruption. Four deceased cases of TEN were treated with corticosteroids with or without IVIG, and 2 of them merged sepsis. Conclusions: Although corticosteroids may enhance the risk of sepsis, prompt treatment with systemic corticosteroids seems to reduces morbidity and improves outcome of SJS and TEN patients.

Journal

  • Japanese Journal of Allergology

    Japanese Journal of Allergology 58(5), 537-547, 2009

    Japanese Society of Allergology

References:  17

Cited by:  2

Codes

  • NII Article ID (NAID)
    110007337985
  • NII NACSIS-CAT ID (NCID)
    AN00012583
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    0021-4884
  • NDL Article ID
    10335360
  • NDL Source Classification
    ZS9(科学技術--医学--病理学・微生物学・寄生虫学・感染・免疫学・血清学・アレルギー)
  • NDL Call No.
    Z19-32
  • Data Source
    CJP  CJPref  NDL  NII-ELS  J-STAGE 
Page Top