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전신적 코티코스테로이드 투여 후 발생한 즉시형 과민반응 1예
이지향 ( Ji-hyang Lee ),오혜선 ( Hye-seon Oh ),권병수 ( Byoung Soo Kwon ),박형준 ( Hyngjun Park ),박소영 ( Soyoung Park ),김정현 ( Jung-hyun Kim ),김효정 ( Hyo-jung Kim ),권혁수 ( Hyouk-soo Kwon ),조유숙 ( You Sook Cho ),문희범 ( 대한천식알레르기학회(구 대한알레르기학회) 2016 Allergy Asthma & Respiratory Disease Vol.4 No.5
Immediate-type hypersensitivity responses to systemic corticosteroids are rare despite their widespread use. It is still controversial whether the responses rarely occur or are underdiagnosed in clinical settings. Many cases probably remain underdiagnosed because the symptoms often mimic symptoms of underlying diseases. This case report describes a 73-year-old man who had immediate hypersensitivity reactions after intravenous administration of hydrocortisone, which was primarily intended to prevent hypersensitivity reactions to contrast media. Whole body rash with pruritus developed shortly after the steroid injection. Since the patient already experienced rash and itching sense after contrast media and antihistamine injection, we conducted skin testing to figure out which drug triggered the hypersensitivity reactions. Intradermal skin tests revealed a positive response to hydrocortisone sodium succinate, which suggested his hypersensitivity reactions were developed by hydrocortisone. Being a common therapy for allergic reaction, corticosteroids themselves are rarely suspected of causing hypersensitivity reactions. Considering there is no typical symptom or standard diagnostic test, awareness of corticosteroid hypersensitivity reactions is of importance to make the diagnosis. (Allergy Asthma Respir Dis 2016:4:378-381)
Primaquine 복용 후 발생한 메트헤모글로빈혈증 1예
이재용 ( Jae Yong Lee ),김성한 ( Sung-han Kim ),안수종 ( Sujong An ),오혜선 ( Hye-seon Oh ),이상영 ( Sang Young Yi ),이훈희 ( Hoon Hee Lee ),한덕종 ( Duck Jong Han ) 대한내과학회 2017 대한내과학회지 Vol.92 No.1
Primaquine은 말라리아 치료제로써 널리 사용되고 있으며, 주폐포자충 폐렴 치료제로써 clindamycin과 병합하여 사용되고 있다. Primaquine의 다양한 부작용은 많은 보고를 통해 알려져 있으며, 메트헤모글로빈혈증은 primaquine의 드문 부작용 중 하나이다. 메트헤모글로빈혈증은 임상 증상 및 검사소견으로 의심할 수 있으며, 이를 확진하기 위해서는 특별한 진단적 접근이 이뤄져야 한다. 저자들은 주폐포자충 폐렴을 치료하기 위해 표준용량의 primaquine을 복용한 후 청색증을 동반한 메트헤모글로빈혈증이 발생한 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Primaquine is often administered for the hypnozoite stage of Plasmodium vivax and Plasmodium ovale. Primaquine (with clindamycin) is also an alternative drug for treatment of pneumocystis pneumonia when trimethoprim/sulfamethoxazole cannot be used. Primaquine may cause methemoglobinemia, an altered state of hemoglobin in which the ferrous state of heme is oxidized to the ferric state. We report a case of methemoglobinemia caused by a standard dose of primaquine plus clindamycin in a 27-year-old female recipient of a kidney transplant who was diagnosed with pneumocystis pneumonia. (Korean J Med 2017;92:94-98)