쯔쯔가무시병에서 azithromycin으로 치료 도중 발생한 torsades de pointes
Torsades de Pointes by Azithromycin in ScrubTyphus and Review on Cardiac Manifestations ofScrub Typhus
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초록
Azithromycins은 경도의 쯔쯔가무시병 치료에서 doxycycline에 비길만하며, 부작용도 적고 임신부나 소아에게도 투여할 수 있다. 드물게 심장 부정맥이 부작용으로 발생할 수 있다. 저자들은 중증 쯔쯔가무시병에서 정주용 azithromycin을 2번 정맥으로 투여한 직후, torsades de pointes가 발생한 예를 경험하였다. Cardioversion으로 정상 리듬으로 회복시켰고 항생제를 doxycycline으로 바꾼 후, 환자는 다른 합병증 없이 퇴원하였다.
Abstract
Azithromycin shows a comparable therapeutic efficacy to doxycycline against mild to moderate scrub typhus. It is safe enough to use in pregnant women or children less than 8 years of age, but may be associated with fatal cardiac dysrhythmia. Herein we report a case of scrub typhus in which torsades de pointes developed during treatment with intravenous azithromycin. A 63-year-old man with a history of hypertension and prolonged QT interval was admitted because of fever with duration of 13 days, rash, an eschar, and delirium. An initial electrocardiography showed atrial fibrillation with rapid ventricular response. Scrub typhus complicated by meningoencephalitis, pneumonitis, and possible myocarditis was diagnosed. Two 500 mg doses of azithromycin were infused over 30 minutes, 12 hours apart. The patient developed a cardiac arrest due to torsades de pointes 30 minutes after the second dose of azithromycin. After the patient was resuscitated successfully and the antibiotic was change to doxycycline. The patient eventually improved and was discharged without any sequelae.
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