小编按：前两期图霸已经给大家介绍了黑色素瘤和维生素 B 缺乏的相关体征，今天我们来给大家介绍一些药物相关的体征，有些需要及时处理，而有些则需要我们对病人做好解释~
羟基脲相关获得性黑甲
Acquired Melanonychia with hydroxyurea
病情：一名用羟基脲治疗血小板增多症的患者在服药 1 年后，出现指甲部分深色，纵行的色素沉着。
鉴别：这一色素沉着需注意与指甲下的黑色素瘤，着色性鳞状细胞癌以及甲下淤血等情况。
类似不良反应药物：环磷酰胺、多柔比星、米诺环素、齐多夫定。
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真皮色素沉着
Dermal Hyperpigmentation
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鞭痕样色素沉着
Flagellate Hyperpigmentation
病情：一名患者在经博来霉素硬化注射治疗血管畸形后，出现了无痛、无瘙痒的鞭痕样的色素沉着。
发病率：在使用博来霉素治疗的患者中，有 20% 的患者会出现鞭痕样色素沉着。
致病机理：皮肤及肺部的博来霉素水解酶含量较少，可能是导致色素沉着的原因；一般在停药后几个月内色素沉着逐渐变淡。
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之前介绍的都是对病人没有太多美观之外的损害的，下面给大家介绍两种比较严重的不良反应。
Stevens-Johnson 综合征
Stevens-Johnson Syndrome, SJS
中毒性表皮坏死松解症
Toxic Epidermal Necrolysis, TEN
SJS 和 TEN 是严重的皮肤黏膜反应，多由药物引发，以表皮的广泛性坏死和剥脱为特点。
SJS 其皮肤剥脱面积小于体表面积的 10%，常有粘膜受累。
TEN 中的皮肤剥脱累及超过 30% 的体表面积且大多数患者存在黏膜受累。
SJS/TEN 重叠用于描述皮肤剥脱面积介于 10%-30% 的患者。
SJS患者的死亡率约为 10%，TEN 患者的死亡率约 50%。
常见致病药物：别嘌醇、芳香族抗癫痫药物、磺胺类抗生素、拉莫三嗪、奈韦拉平、非甾体类抗炎药。
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A 30-year-old obese woman with no significant past medical history presents to the ED complaining of shortness of breath and coughing up blood-streaked sputum. The patient states that she traveled to Moscow a month ago. Upon returning to the United States, the patient developed a persistent cough associated with dyspnea. She was seen by a pulmonologist, who diagnosed her with bronchitis and prescribed an inhaler. However, over the following weeks, the patient's symptoms worsened, and she developed pleuritic chest pain. In the ED, she lets you know that she smokes half a pack per day. Her vitals include a temperature of 99°F, BP of 105/65 mm Hg, HR of 124 beats per minute, RR of 22 breaths per minute, and an oxygen saturation of 94% on room air. Physical examination is noncontributory, except for rales at the left-mid lung. Her ECG reveals sinus tachycardia with large R waves in V1 to V3 and inverted T waves. Given this patient's history and presentation, what is the most likely etiology of her symptoms?
题目来源：既往 USMLE 题
本期主播：闲闲闲兔
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参考文献：
1. First Aid for the USMLE Step 1 (2017)
2. uptodate
3. Wikipedia.org
图片声明：未特殊注明者图片取自网络
回复关键词「药物不良反应」可随时查看本文。
编辑：毕日阳古
质控：一枝黄花
