摘要
Abstract
Objective To investigate the clinical features,causes of misdiagnosis and preventive measures of drug-induced liver injury(DILI)by Azithromycin.Methods The clinical data of 11 patients with DILI by Azithromycin misdiag-nosed from February 2020 to October 2022 were retrospectively analyzed.Results Among the 11 patients,5 were males and 6 were females,aged 6-58 years.Two patients were admitted to hospital with fever,cough and chest tightness,and were ini-tially diagnosed as pneumonia.One patient was admitted to the hospital with fever and joint pain and was initially diagnosed as rheumatoid arthritis.Three patients were admitted to the hospital with skin pruritus and rash,which were initially diagnosed as allergic rash.Five patients were admitted to hospital with anorexia,fatigue,nausea and upper abdominal discomfort,and were initially diagnosed as gastritis.After corresponding treatment,the initial symptoms did not improve,and 6 patients showed dif-ferent degrees of jaundice and liver discomfort.Abnormal liver function tests were performed in 11 patients.Liver ultrasound showed no obvious abnormality in 1 patient.In 8 patients,the liver contour was normal,the liver solid echo was reduced,and the density was sparse.In 2 patients,the liver was slightly enlarged,and the liver parenchymal spot was brightened and thick-ened,with high echo and uneven distribution.All patients had a history of acute upper respiratory tract infection and use of Azithromycin.They were diagnosed as DILI by Azithromycin.The misdiagnosis lasted 1-2 d.All 11 patients were treated with liver protection,detoxification and enzyme reduction.The initial symptoms were significantly relieved,the liver function grad-ually returned to normal,and the liver damage degree was significantly improved by ultrasound examination of the liver,with good prognosis.Conclusion The clinical manifestations of DILI are different and lack of specificity,and the initial symptoms can be a variety of extra-hepatic manifestations,which is more likely to cause misdiagnosis.Most patients can recover after stopping the drug.Therefore,clinicians should improve their ability to diagnose DILI,and clinical pharmacists should actively participate in clinical ward rounds and pharmaceutical consultations to strengthen medication guidance and reduce the occur-rence of DILI.关键词
药物性肝损伤/阿奇霉素/误诊/肺炎/类风湿关节炎/过敏性皮疹/胃炎/肝功能Key words
Drug-induced liver injury/Azithromycin/Misdiagnosis/Pneumonia/Arthritis,rheumatoid/Allergic skin rash/Gastritis/Liver function分类
临床医学
