Abstract: Objective　To observe the effect of tumor necrosis factor-α (TNF-α) antagonist combined with small-medium dose of glucocorticoids in severe drug eruption. Method　We summarized the incidence and outcome of 2 cases of severe drug eruption in Wuxi No.2 People's Hospital Affiliated to Nanjing Medical University. Results　Case 1: a 52-year-old male, took carbamazepine orally for right facial trigeminal neuralgia 31 days before admission, and had fever, systemic rash, and elevated white blood cell (WBC) and C-reactive protein (CRP) levels, accompanied by liver function impairment. He was diagnosed as Stevens-Johson syndrome, was treated with subcutaneous injection of 25 mg (initial dose not doubled) etanercept once every 3 days for 4 times, the corresponding dose of glucocorticoids was 60, 40, 20, and 20 mg, and the patient recovered. Fever was controlled within 6 hours after the first injection; 3 days later, the lesions began to desquamate, and 5 days later, the epidermis regenerated. Levels of WBC, CRP, and transaminase in the peripheral blood began to decrease after the first injection, and returned to normal in 1 week. Case 2: a 68-year-old female, took allopurinol orally due to gout 3 weeks before admission, had high fever, oliguria, and systemic rash, accompanied by liver and kidney function impairment, increased WBC and eosinophils, and lymph node enlargement. She was diagnosed as drug reactions with eosinophilia and systemic symptoms (DRESS), was treated with etanercept with the dose as same as case 1, and the corresponding dose of glucocorticoids was 60, 40, 40, and 20 mg. Fever was controlled within 6 hours after the first injection; 3 days later, the skin began to desquamate, and 7 days later, 80% of the rash subsided. WBC and CRP in the peripheral blood began to decrease after the first injection, transaminase and eosinophils continued to increase, and gradually recovered in 2 weeks. Follow-up up to now showed no recurrence in 2 patients. Conclusion　It is suggested that TNF-α antagonist combined with small-medium dose of glucocorticoids can promote the outcome of severe drug eruption more quickly, safely, and effectively in the early stage.

Key words: Tumor necrosis factor-α, Glucocorticoids, Toxic epidermal necrolysis, DRESS

摘要： 目的　观察肿瘤坏死因子α（TNF-α）拮抗剂联合中小剂量糖皮质激素在重症药疹中的作用。方法　总结南京医科大学附属无锡第二人民医院2020年收治的2例重症药疹发病及转归。结果　（1）例1患者男，52岁，31 d前因右面部三叉神经痛口服卡马西平，发热、全身皮疹，白细胞、C反应蛋白（CRP）升高伴肝功能损害，诊断：Stevens-Johson综合征。给予益赛普25 mg（首剂未加倍）皮下注射，1次/3 d，共4次，糖皮质激素相应剂量为60、40、20、20 mg，获得痊愈。首次注射后，6 h内发热即控制；3 d后皮损开始脱屑，5 d后表皮新生。注射1次后，外周血白细胞、CRP、转氨酶开始下降，1周内恢复正常。（2）例2患者女，68岁，3周前因痛风口服别嘌呤醇，高热、少尿、全身皮疹伴有肝肾功能损害、白细胞和嗜酸性粒细胞增多、淋巴结肿大，诊断：药物反应伴嗜酸性粒细胞增多和全身性症状（DRESS）。益赛普剂量同例1，激素相应剂量为60、40、40、20 mg。首次注射后，6 h内发热即控制；3 d后面部开始脱屑，7 d后80%皮疹消退。注射1次后，外周血白细胞、CRP开始下降，转氨酶、嗜酸性粒细胞持续上升，2周内逐渐恢复。（3）2例患者随访至今，无复发。结论　TNF-α拮抗剂联合中小剂量糖皮质激素能在早期更快速、安全、有效地促进重症药疹转归。

关键词: 肿瘤坏死因子α, 糖皮质激素, 中毒性表皮坏死松解症, 药物反应伴嗜酸性粒细胞增多和全身性症状