左氧氟沙星抗结核治疗致中毒性表皮坏死松解症1例报道

doi:10.19871/j.cnki.xfcrbzz.2026.02.013

摘要/Abstract

摘要： 本文报道1例因使用左氧氟沙星进行抗结核治疗引起中毒性表皮坏死松解症（toxic epidermal necrolysis,TEN）的病例。患者肺癌治疗后并发活动性肺结核,后出现了由抗结核药物诱发的罕见而致命的TEN。诊疗上立即停用可疑药物,使用表皮坏死松解症药物因果关系算法分析,确认左氧氟沙星为致病药物,TEN严重程度评分评估患者病死率达62%。治疗团队联用糖皮质激素、免疫球蛋白、TNF-α拮抗剂治疗TEN,同时启动强效的二线抗结核治疗,有效降低免疫治疗诱发结核菌播散的风险。在TEN痊愈后,治疗团队实施了药物激发试验,验证了患者对异烟肼、乙胺丁醇、吡嗪酰胺的耐受性,并以此制定后续的抗结核方案。本病例不仅警示了左氧氟沙星导致TEN的罕见严重风险,也为肺结核合并TEN的诊疗提供参考。

关键词: 中毒性表皮坏死松解症, 结核病, 左氧氟沙星

Abstract: This report describes a case of levofloxacin-induced toxic epidermal necrolysis (TEN) occurring during antituberculosis therapy. A patient developed active pulmonary tuberculosis following treatment for lung cancer and subsequently experienced a rare and potentially fatal case of toxic epidermal necrolysis induced by anti-tuberculosis drugs. In clinical management, suspicious medications were immediately discontinued, and an analysis using the Algorithm of Drug Causality for Epidermal Necrolysis identified levofloxacin as the causative drug. The Severity-of-Illness Score for Toxic Epidermal Necrolysis estimated the patient's mortality risk at 62%. To manage TEN, the treatment team initiated a combination of corticosteroids, immunoglobulins, and TNF-α antagonists, while concurrently starting intensive second-line anti-tuberculosis therapy. This approach effectively reduced the risk of tuberculosis dissemination triggered by immunotherapy. Following the resolution of TEN, a drug provocation test was performed to evaluate the patient's tolerance to isoniazid, ethambutol, and pyrazinamide, which subsequently informed the formulation of a revised anti-tuberculosis regimen. This case underscores the rare and severe risk of TEN induced by levofloxacin and provides valuable insights into the management of pulmonary tuberculosis complicated by TEN.

Key words: Toxic epidermal necrolysis, Tuberculosis, Levofloxacin

中图分类号:

R521
R758

胡少瑜, 冯艳仪, 戚振红. 左氧氟沙星抗结核治疗致中毒性表皮坏死松解症1例报道[J]. 新发传染病电子杂志, 2026, 11(2): 66-70.

Hu Shaoyu, Feng Yanyi, Qi Zhenhong. A case report of toxic epidermal necrolysis induced by levofloxacin during anti-tuberculosis treatment[J]. Electronic Journal of Emerging Infectious Diseases, 2026, 11(2): 66-70.

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