注射用硫酸多粘菌素B致皮肤色素沉着1例分析

doi:10.19803/j.1672-8629.2021.05.18

中国药物警戒 ›› 2021, Vol. 18 ›› Issue (5): 489-491.
DOI: 10.19803/j.1672-8629.2021.05.18

注射用硫酸多粘菌素B致皮肤色素沉着1例分析

陈建寿¹, 王敏^2,*

¹儋州市人民医院,海南儋州 571700;
²海南省人民医院,海南医学院附属海南医院,海南海口 570100

收稿日期:2019-12-10 出版日期:2021-05-15 发布日期:2021-05-12
通讯作者: ^*王敏,女,硕士,副主任药师,临床药学。E-mail:15799077523@163.com
作者简介:陈建寿,男,本科,主管药师,临床药学。
基金资助:
海南省科技厅重点研发项目（ZDYF2019141）

One Case of Skin Pigmentation Induced by Polymyxin B for Injection

CHEN Jianshou¹, WANG Min^2,*

¹Danzhou People's Hospital, Danzhou Hainan 571700, China;
²Hainan General Hospital, Hainan Hospital Affiliated to Hainan Medical College, Haikou Hainan 570100, China

Received:2019-12-10 Online:2021-05-15 Published:2021-05-12

摘要/Abstract

摘要： 目的分析注射用硫酸多粘菌素B致皮肤色素沉着的可能因素,促进临床合理用药。方法分析1例多粘菌素B致皮肤色素沉着患者的诊疗经过,结合文献检索,探讨诱发皮肤色素沉着的机制及应对措施。结果患者静脉使用多粘菌素B后第14天观察到头、颈部皮肤出现色素沉着,考虑合并用药西罗莫司血药浓度蓄积所致,将西罗莫司剂量减半并监测该药血药浓度,发现西罗莫司在有效血药浓度范围内。第30天患者感染得到控制,停用多粘菌素B,此时患者全身皮肤呈深棕褐色,随访5个月全身皮肤较前明显转淡,但未恢复常态。结论多粘菌素B引起的皮肤色素沉着应选择替代治疗方案,如确实需要继续使用应避免同时或相继使用神经毒性或肾毒性药物,并在治疗期间监测肾功能和多粘菌素B血药水平。

关键词: 多粘菌素B, 皮肤色素沉着, 药物相关副作用

Abstract: Objective To analyze the possible factors of skin pigmentation caused by polymyxin B for injection and promote the rational use of drugs in clinic. Methods The diagnosis and treatment of a case of skin pigmentation caused by polymyxin B were analyzed and combined with literature search to explore the mechanism and countermeasures of skin pigmentation induced. Results On the 14th day after the patient's intravenous administration of polymyxin B, the patient's head and neck skin were observed to be pigmented. Considering the combination of sirolimus blood concentration accumulation, reduce the sirolimus dose by half and monitor the drug Blood concentration. It was found that sirolimus was within the effective blood concentration range. The infection was controlled on the 30th day, and polymyxin B was discontinued. At this time, the patient's body skin was dark brown, and the patient's body skin was followed up for 5 months. Significantly weaker than before, but did not return to normal. Conclusion Alternative treatment options should be selected for polymyxin B-induced skin pigmentation. If continued use is warranted, simultaneous or sequential use of neurotoxic or nephrotoxic drugs should be avoided, and renal function and polymyxin B blood levels should be monitored during treatment.

Key words: polymyxin B, skin pigmentation, drug-related side effects

中图分类号:

R969.3

陈建寿, 王敏. 注射用硫酸多粘菌素B致皮肤色素沉着1例分析[J]. 中国药物警戒, 2021, 18(5): 489-491.

CHEN Jianshou, WANG Min. One Case of Skin Pigmentation Induced by Polymyxin B for Injection[J]. Chinese Journal of Pharmacovigilance, 2021, 18(5): 489-491.

参考文献

[1] Storm DR,Rosenthal KS,Swanson PE.Polymyxin and related peptide antiibiotics[J].Annu Rev Biochem,1977,46:723-763.
[2] Hu FP,Guo Y,Zhu DM,et al.Antimicrobial resistance profile of clinical isolates in hospitals across China:report from the CHINET Surveillance Program,2017[J].Chinese Journal of Infection and Chemotherapy(中国感染与化疗杂志),2018,18(3):241-251.
[3] Chinese XDR Consensus Working Group,Guan XD,He LX,et al.Laboratory diagnosis,clinical management and infection control of the infections caused by extensively drug-resistant Gram-negative bacilli:a Chinese conse-nsus statement[J].Clinical Microbiology and Infection,2016:22:S15-S25.
[4] Tran TB,Velkov T,Nation RL,et al.Pharmacokinetics-pharmacodynamics of colistin and Polymyxin B:are we there yet?[J].Int J Antimicrob Agents,2016,48(6):592-597.
[5] Chen Y,Mai SX,Wen XR,et al.Literature analysis of skin pigmentation in adult patients induced by polymyxin B[J].Chinese Journal of Drug Applic-ation and Monitoring(中国药物应用与监测),2019,16(3):161-164.
[6] Mattos KPH,Cintra ML,Gouvea IR,et al.Skin hyperpigmentation following intravenous polymyxin B treatment associated with melanocyte activation and inflammatory process[J].J Clin Pharm Ther,2017,42(5):573-578.
[7] Bushby SR,Green AF.The release of histamine by polymyxin b and polymyxine[J].British Journal of Pharmacology and Chemotherapy,1955,10(2):215-219.
[8] Yoshida M,Takshashi Y,Inoue S.Histamine induces melanogenesis and morphologic changes by protein kinase A activation via H2 receptors in human normal melanocytes[J].J Invest Dermatol,2000,114(2):334-342.
[9] Slater D,Histologic diagnosis of inflammatory skin diseases An algorithmic method based on pattern analysis,3 rdedu[J].Histopathology,2005,47(6):707-708.
[10] Zheng GH,Cao L,Che ZQ,et al.Polymyxin B-induced skin hyperpigmentation:a rare case report and literature review.[J].BMC pharmacology &toxicology,2018,19(1):41.
[11] Knueppel RC,Rahimian J.Diffuse cutaneous hyperpingmentation due to tigecycline or polymyxin B[J].Clin Infect Dis,2007,45(1):136-138.
[12] Kronenfeld MA,Thomas SJ,Turndorf H.Recurrence of neuromuscular blockade after reversalofvecuronium in a patient receiving polymyxin-amikacin sternal irrigation[J].Anesthesiology,1986 (65):93-94.
[13] Lindesmith LA,Baines RD Jr,Bigelow DB,et al.Reversible respiratory paralysis associated with polymyxintherapy[J].Ann Intern Med,1968(68):318-327.
[14] Fogdall RP,Miller RD.Prolongation of a pancuronium-induced neuro-muscular blockade by polymyxin B[J].Anesthesiology,1974 (40):84-87.
[15] Gebbie D.Colistimethate and curare:a case report[J].Anesth Analg,1971 (50):109-111.
[16] Zauder HL,Barton N,Bennett EJ,et al.Colistimethate as a cause of postoperative apnoea[J].Can AnaesthSoc J,1966 (13):607-610.
[17] Justin R,LenhardT,Roger L,et al.Synergistic combinations of polymyxins[J].International Journal of Antimicrobial Agents,2016,48(6):241-244.
[18] Liang BB,Wang R,Wang J,et al.Bibliometric analysis of polymyxin nephrotoxicity literature based on Web of Science[J].Chinese Journal of Pharmacovigilance(中国药物警戒),2015,12(12):756-759.
[19] Oliveir AM,Prado GVB,Costa SF,et al.Polymyxin B and colistimethate are comparable as to efficacy and renal toxicity[J].Diagn MicrInfec Dis,2009,65(4):431-434.
[20] Falagas ME,Rizos M,Bliziotis IA,et al.Toxicity after prolonged (more than four weeks) administration of intravenous colistin[J].BMC Infect Dis,2005(5):1.

注射用硫酸多粘菌素B致皮肤色素沉着1例分析

One Case of Skin Pigmentation Induced by Polymyxin B for Injection

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