Drug-induced hypersensitivity syndrome due to ibuprofen sustained release capsules

Abstract

A 63-year-old female with postherpetic neuralgia received ibuprofen sustained release capsules 0.3 g twice daily. On day twelve after medication, the patient developed papula, erythema accompanied by pruritus on her body and arms and legs. On day seventeen, the oedema occurred on her face. On day twenty, she had high fever. Laboratory tests revealed the following results: white blood cell (WBC) 26×109/L, neutrophile granulocyte 0.46, eosinophils 0, C-reactive protein (CRP) 38.6 mg/L, procalcitonin (PCT) 16.46 μg/L, alanine aminotransferase (ALT) 329 U/L, aspartate aminotransferase (AST) 291U/L, lactate dehydrogenase (LDH) 1 089 U/L, creatine kinase isoenzyme (CK-MB) 35 U/L, and myoglobin (MYO)116 μg/L. She was diagnosed as drug-induced hypersensitivity syndrome due to ibuprofen sustained release capsules. Ibuprofen sustained release capsules was stopped. The patient received the treatment including IV infusion of methylprednisolone, compound glycyrrhizin injection, sodium thiosulfate, immunoglobulin, oral administration of desloratadine tablets and levocetirizine hydrochloride tablets, and external application of desonide cream. On day 13 of drug withdrawal, her facial oedema was subside largely, the color of erythema changed to dark, and erythra decreased obviously. Laboratory tests revealed the following results: WBC 15×109/L, neutrophile granulocyte 0.5, eosinophils 0.04, CRP 7.6 mg/L, PCT 0.92 μg/L, ALT 239 U/L, AST 61 U/L, LDH 393 U/L, CK-MB 20 U/L, MYO 42 μg/L. On day 56 of drug withdrawal, the patient′s erythema was disappeared completely and the skin color was normal basically. Laboratory tests revealed the following results: ALT 63 U/L, AST 36 U/L, LDH 98 U/L, CK-MB 12 U/L, MYO 25 μg/L. Key words: Ibuprofen; Hypersensitivity