1例28岁女性患者,因原发性甲状腺功能低下,给予进口左甲状腺素25μg,每天1次;7 d后,躯干及四肢出现红斑、丘疹并伴瘙痒,皮损渐增多,泛发全身。实验室检查:WBC 13.63×109/L,E 0.32。血生化:CK 662 U.L-1。骨髓图片检查提示,嗜酸细胞增多。心脏彩超提示,心包积液1.0 cm。停用进口左甲状腺素,改为国产左甲状腺素口服,并给予甲强龙32 mg静滴,6天后症状好转。
A 28-year-old woman with constitutional thyroid hypofunction received imported levothyroxine 25 μg once daily.After 7 days of therapy,the patient experienced erythema and papular eruption on her trunk and limbs.Subsequently,her symptoms worsened and she presented with generalized skin damage,erythema,popular eruption with itching.Laboratory examinations revealed a WBC count of with 13.63×109 L-1,eosinophils 0.32 and an CK level of 662 U·L-1.A bone marrow smear showed her eosinophils increased.3D color and power ultrasonography in heart show hydropericardium of 1.0 cm.Levothyroxine(Euthyrox,produced by Merck,German) was substituted with levothyroxine tablets(Jiaheng,produced by China associated pharmaceuticals).Then,the patient was treated with an iv infusion of methylprednisolone 32 mg dissolved in 5% glucose 250 mL.Six days later,her symptoms improved.