Scarlatiniform erythema drug eruption induced by amiodarone hydrochloride injection

Abstract

A 65-year-old female patient with hepatitis B cirrhosis, pulmonary infection, abdominal infection and respiratory failure received lactulose oral solution, furosemide, spironolactone, entecavir, potassium chloride injection, polyene phosphatidyl choline, ademetionine 1, 4-butanedisulfonate, reduced glutathione, human albumin, thymopentin, vitamin K1, L-ornithine L-aspartate, piperacillin sodium tazobactam sodium, teicoplanin, methylprednisolone sodium succinate, compound glycyrrhizin, lanso-prazole, kuhuang injection(苦黄注射液) and salbutamol sulfate solution. Amiodarone hydrochloride injection 0.15 g was given to the patient by slow intravenous infusion due to atrial fibrillation, and then the drug was diluted by 5% glucose injection to 10 mg/ml by a continuous infusion pump delivering 3 ml/h. On day 2, scattered rash appeared on her left thigh. On day 3, the rash extended to the left leg, piperacillin sodium tazobactam sodium and teicoplanin were stopped. She was given intramuscular injection of promethazine hydrochloride 25 mg and intravenous injection of calcium gluconate 1 g, the rash area decreased. That night, the heart rate of the patient was up to 128 beats/min, and the injection pump speed of amiodarone hydrochloride was adjusted for 6 ml/h. The next day, the rash throughout the limbs and chest, kuhuang injection was stopped and oral cyproheptadine hydrochloride 4 mg twice daily was given. On day 7, the patient developed generalized diffuse erythema, thymopentin and compound glycyrrhizin were stopped. On day 8, the rash exacerbated accompanied by desquamation. Scarlatiniform erythema drug eruption induced by amiodarone hydrochloride was considered. Amiodarone hydrochloride was withdrawn. She was given intravenous injection of dexamethasone 10 mg and calcium gluconate 1 g. The next day, the rash subsided significantly. Key words: Amiodarone; Drug rush