左氧氟沙星片致中毒性表皮坏死松解症1例分析

doi:10.19803/j.1672-8629.20260406

摘要/Abstract

摘要： 目的探讨左氧氟沙星片致中毒性表皮坏死松解症（TEN）的病例及其可能发生机制,为临床安全用药提供参考。方法分析1例口服左氧氟沙星片0.5 g致TEN的病例,明确TEN为可疑药物,查阅相关文献,并总结其发生机制、治疗策略等。结果患者在使用左氧氟沙星片约2 h后发生TEN,结合其用药史,判定TEN与左氧氟沙星片的关联性评价为“很可能”。停用左氧氟沙星片的基础上采取积极治疗措施,患者症状逐步缓解。结论临床使用左氧氟沙星片时可发生TEN,虽然TEN的发生率较低,但病情进展迅速且有潜在致死性,应引起足够重视。一旦确诊,应积极救治患者以保证预后。

关键词: 左氧氟沙星片, 中毒性表皮坏死松解症, 腹泻, 药品不良反应

Abstract: Objective To investigate the potential mechanisms and therapeutic regimens of toxic epidermal necrolysis (TEN) caused by levofloxacin tablets so as to provide references for safe clinical medication. Methods The clinical data of a patient with diarrhea who developed TEN after oral administration of 0.5 g levofloxacin tablets were analyzed. The suspected causative drug was identified, and the potential mechanisms and therapeutic regimens of TEN were summarized. Results TEN occurred approximately 2 hours after levofloxacin tablet administration. Combined with the patient’s history of medication, the causal relationship between TEN and levofloxacin tablets was assessed as “probable”. After discontinuation of levofloxacin tablets and initiation of active therapeutic regimens, the patient’s symptoms gradually improved. Conclusion This case indicates that levofloxacin tablets may trigger TEN in susceptible patients. Despite its low incidence, TEN progresses rapidly and carries potential fatal risks, which requires sufficient clinical vigilance. Once it is diagnosed, prompt and aggressive management should be instituted to ensure a favorable prognosis.

Key words: Levofloxacin Tablets, Toxic Epidermal Necrolysis, Diarrhea, Adverse Drug Reaction

中图分类号:

崔银宁, 杨雪萍, 戚娜婕, 石秀江. 左氧氟沙星片致中毒性表皮坏死松解症1例分析[J]. 中国药物警戒, 2026, 23(10): 1181-1184.

Cui Yinning, Yang Xueping, Qi Najie, Shi Xiujiang. One case of toxic epidermal necrolysis caused by levofloxacin tablets[J]. Chinese Journal of Pharmacovigilance, 2026, 23(10): 1181-1184.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://zgywjj.magtechjournal.com/CN/10.19803/j.1672-8629.20260406

https://zgywjj.magtechjournal.com/CN/Y2026/V23/I10/1181

参考文献

[1] Uppal E, Dear K, Exton L, et al.The case for etanercept in the management of toxic epidermal necrolysis[J]. Skin Health Dis, 2025, 5(4): 247-255.
[2] Duan Fuyong, Song Jia, Hu Xiaoqi, et al.Case analysis of individual cases of adverse drug reactions induced by serplulimab based on literature reports[J]. Journal of China Prescription Drug(中国处方药), 2026, 24(8): 44-50.
[3] Liao Wenzhi, Liu Pengcheng.Mining and analysis of levofloxacin safety alert signals based on spontaneous reporting data from China adverse drug reaction monitoring[J]. Central South Pharmacy(中南药学), 2025, 23(5): 1479-1485.
[4] Zhang Xuehua, Cao Xue, Gong Cao, et al.Literature analysis of Stevens-Johnson syndrome and toxic epidermal necrolysis induced by quinolones[J]. Chinese Journal of Hospital Pharmacy(中国医院药学杂志), 2022, 42(2): 165-171.
[5] Li X, Yan Z, Chen S, et al.Potential drugs associated with toxic epidermal necrolysis: a disproportionality analysis based on the FAERS database (2004-2024)[J]. Arch Dermatol Res, 2025, 317(1): 647.
[6] Chen Kuixia, Pan Dan, Li Li, et al.Toxic epidermal necrolysis due to levofloxacin injection[J]. Adverse Drug Reactions Journal(药物不良反应杂志), 2020, 22(9): 537-538.
[7] Xu Lijun, Li Xingxia.One suspected case of toxic epidermal necrolysis induced by levofloxacin[J]. Chinese Journal of Drug Application and Monitoring(中国药物应用与监测), 2015, 12(4): 258-260.
[8] Bian Hailin.Bullous epidermolysis type drug eruption and renal damage induced by levofloxacin[J]. Herald of Medicine(医药导报), 2010, 12(5): 362.
[9] Chen Mingling, Deng Jingliang, Huo Yandan, et al.Integrated traditional Chinese and western medicine treatment for a case of toxic epidermal necrolysis induced by levofloxacin[J]. Journal of Sichuan Traditional Chinese Medicine(四川中医), 2010, 28(5): 110.
[10] Yang Yunqi, Wang Qiushi, Zhang Lei, et al.One case of Lyell syndrome caused by levofloxacin[J]. Medical Journal of National Defending Forces in Southwest China(西南国防医药), 2018, 28(7): 689.
[11] 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(新发传染病电子杂志), 2026, 11(2): 66-70.
[12] Varma S K, Sutradhar S, Misra A K.Levofloxacin and furazolidone induced toxic epidermal necrosis[J]. Indian J Pharmacol, 2013, 45(6): 625-626.
[13] Uzun R, Yalcin A D, Celik B, et al.Levofloxacin induced toxic epidermal necrolysis: successful therapy with omalizumab (anti-IgE) and pulse prednisolone[J]. Am J Case Rep, 2016, 17: 666-671.
[14] Khan A A, Aisha U, Hassan A, et al.Levofloxacin-induced toxic epidermal necrolysis[J]. Cureus, 2023, 15(5): e39504.
[15] Gajjar K, Hirapara H, Jaiswal C S, et al.A case report of antitubercular drugs induced exanthematous reaction complicated by acute onset levofloxacin induced toxic epidermal necrolysis (TEN)[J]. Curr Drug Saf, 2018, 13(1): 41-43.
[16] Wang X, Cheng G, Liang X, et al.Toxic epidermal necrolysis observed in a patient with the HLA-B*1502 treated with levofloxacin[J]. Clin Ther, 2024, 46(12): 1082-1085.
[17] Ministry of Health. Provisions for Adverse Drug Reaction Reporting and Monitoring[EB/OL].(2011-05-04)[2026-07-24]. https://www.nmpa.gov.cn/.
[18] Lamture V Y Sr, Lamture Y R Sr, Uke P Sr. Stevens-Johnson syndrome induced by Herbal Kadha[J]. Cureus, 2023, 15(7): e42407.
[19] García-Cortés M, Matilla-Cabello G, Lucena M I.Methods for causality assessment of idiosyncratic drug-induced liver injury[J]. Liver Int, 2025, 45(3): e16083.
[20] Jiang M, Yang J, Yang L, et al.An association study of HLA with levofloxacin-induced severe cutaneous adverse drug reactions in Han Chinese[J]. iScience, 2023, 26(8): 107391.
[21] Sooranahalli C, Rao R V, Zelman B, et al.The potential roles of IL-1β, IL-6, and RIPK3 in the pathogenesis of Stevens-Johnson syndrome/toxic epidermal necrolysis[J]. Diagnostics (Basel), 2025, 15(3): 290.
[22] Lee A Y.Immunological mechanisms in cutaneous adverse drug reactions[J]. Biomol Ther, 2024 , 32(1): 1-12.
[23] Cao J, Zhang X, Xing X, et al.Biologic TNF-α inhibitors for Stevens-Johnson syndrome, toxic epidermal necrolysis, and TEN-SJS overlap: a study-level and patient-level meta-analysis[J]. Dermatol Ther (Heidelb), 2023, 13(6): 1305-1327.
[24] Shah H, Parisi R, Mukherjee E, et al.Update on Stevens-Johnson syndrome and toxic epidermal necrolysis: diagnosis and management[J]. Am J Clin Dermatol, 2024, 25(6): 891-908.
[25] Heuer R, Paulmann M, Annecke T, et al.S3 guideline: Diagnosis and treatment of epidermal necrolysis (Stevens-Johnson syndrome and toxic epidermal necrolysis)-Part 1: diagnosis, initial management, and immunomodulating systemic therapy[J]. J Dtsch Dermatol Ges, 2024, 22(10): 1448-1466.
[26] Adverse Drug Reaction Research Center of Chinese Society of Derma-tology. Expert consensus on the diagnosis and treatment of Stevens-Johnson syndrome/toxic epidermal necrolysis[J]. Chinese Journal of Dermatology(中华皮肤科杂志), 2021, 54(5): 376-381.
[27] Yao L, Su X, Liu L, et al.Recent developments in the research of Stevens-Johnson syndrome and toxic epidermal necrolysis: pathogenesis, diagnosis and treatment[J]. Eur J Med Res, 2025, 30(1): 453.
[28] Watanabe Y, Hama N.Recent advances in the diagnosis and treatment of Stevens-Johnson syndrome/toxic epidermal necrolysis[J]. Allergol Int, 2025, 74(3): 345-355.
[29] Liu J, Zhou M, Li T, et al.Adalimumab combination with corticosteroid therapy for Stevens-Johnson syndrome/toxic epidermal necrolysis[J]. Arch Dermatol Res, 2025, 317(1): 694.