scholarly journals Hydroxychloroquine-induced Stevens–Johnson syndrome in COVID-19: a rare case report

2020 ◽  
Vol 2020 (6) ◽  
Author(s):  
Lotfollah Davoodi ◽  
Hamed Jafarpour ◽  
Armaghan Kazeminejad ◽  
Eissa Soleymani ◽  
Zahra Akbari ◽  
...  
Keyword(s):  
Multiorgan Failure ◽  
Severe Pneumonia ◽  
Respiratory Illness ◽  
Maculopapular Rash ◽  
Stevens Johnson Syndrome ◽  
Entire Body ◽  
Inflammatory Reactions ◽  
Johnson Syndrome ◽  
Rare Case Report ◽  
Tract Involvement

Abstract The international outbreak of respiratory illness termed coronavirus disease 2019 (COVID-19) began in December 2019 that has affected >0.8 million individuals. Self-limiting respiratory tract involvement, severe pneumonia, multiorgan failure and death are the spectrum of COVID-19. To date, there are no especial therapeutic agents for COVID-19 infections. One such medication includes the antimalarial hydroxychloroquine (HCQ), which recently reported as a possible therapy for shortening the duration of COVID-19 symptoms, reducing inflammatory reactions to infection, impairing the exacerbation of pneumonia and boosting lung imaging findings. Like all medications, HCQ has side effects and may occur in COVID-19 patients. Here, we report on the case of a 42-year-old woman, presented with fever and dry cough, who had COVID-19 and 2 days later presented with a pruritic erythematous maculopapular rash, which started from the distal of upper extremities and rapidly, involved the entire body.

scholarly journals Hydroxychloroquine-Induced Stevens-Johnson Syndrome in COVID-19: A rare Case Report

2020 ◽  
Author(s):  
Lotfollah Davoodi ◽  
Hamed Jafarpour ◽  
Armaghan Kazeminejad ◽  
Eissa Soleymani ◽  
Zahra Akbari ◽  
...  
Keyword(s):  
Side Effects ◽  
Ground Glass Opacity ◽  
Respiratory Illness ◽  
Upper Extremities ◽  
Definitive Treatment ◽  
Stevens Johnson Syndrome ◽  
Nasopharyngeal Swab ◽  
Entire Body ◽  
Her Family ◽  
Johnson Syndrome

Abstract Background: The international outbreak of respiratory illness termed coronavirus disease 2019 (COVID-19) began in December 2019 that has affected more than 0.8 million individuals. To date, there are no specific therapeutic agents for coronavirus infections. One of the drugs that have an effective role in improving the condition of patients with COVID-19 is hydroxychloroquine (HCQ). This drug is not a definitive treatment for this disease and has a supportive role. Like all medications, HCQ has side effects and may occur in COVID-19 patients. Stevens-Johnson syndrome caused by HCQ is very rare.Case presentation: A 42-year-old woman, presented with fever and dry cough in the past two days to her family physician. Lab tests revealed elevated lactate dehydrogenase (LDH, 648 units/liter (U/L)), C-reactive protein level (CRP, 52 milligrams/Liter (mg/L), normal: <10 mg/L), aspartate aminotransferase (AST, 59 U/L, normal: 10-40 U/L), thrombocytopenia, and leukopenia. Mild bilateral patchy ground-glass opacity was seen in lung CT-Scan. Due to COVID-19 pandemic and clinical findings, the nasopharyngeal swab test was done and SARS-CoV-2 nucleic acid was detected by RT-PCR. HCQ 200 mg twice daily was started. After two days, the patient presented with a pruritic erythematous maculopapular rash and flat atypical targets that started from the distal of upper extremities and rapidly, involved the entire body, and torn blisters which were only be seen as ulcers on orolabial area. The Nikolsky sign was positive. Due to the likelihood of a drug reaction, HCQ was discontinued, and COVID-19 treatment was changed to lopinavir/ritonavir (LPV/RTV) 400 mg twice daily. Finally, she was discharged after five days with nonpruritic scalded skin on the distal of upper extremities. Conclusions: It is worth noting that although HCQ appears to be safe and has mild side effects, however, the boundary between therapeutic and toxic doses is narrow and severe disorders of their use can life-threatening. One of the side effects of HCQ is SJS caused by the drug, and given the worldwide pandemic of COVID-19 and the increasing need for this drug, we need to be careful about its use in order to control and manage the side effects of this drug.

scholarly journals Atezolizumab-Induced Stevens-Johnson Syndrome in a Patient with Non-Small Cell Lung Carcinoma

2018 ◽  
Vol 10 (2) ◽  
pp. 198-202 ◽  
Author(s):  
Phatcharawat Chirasuthat ◽  
Pamela Chayavichitsilp
Keyword(s):  
Case Report ◽  
Immune Checkpoint ◽  
Small Cell Lung Carcinoma ◽  
Maculopapular Rash ◽  
Small Cell ◽  
Stevens Johnson Syndrome ◽  
Small Cell Lung ◽  
Cell Lung Carcinoma ◽  
Johnson Syndrome ◽  
Inpatient Settings

Atezolizumab is a humanized anti-PD-L1 immune checkpoint antibody that is currently used in many kinds of advanced carcinoma including metastatic non-small cell lung cancer. The cutaneous side effect profile reported only 20% of the patients which had only mild maculopapular rash that required no treatment. There is no case report of anti-PD-L1 antibody-induced Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) eruptions. To the best of our knowledge, there is no case report of atezolizumab-induced SJS or SJS/TEN induced by anti-PD-L1 immune checkpoint antibodies. We believe that our report will be useful to dermatologists who are consultants in the inpatient settings, as atezolizumab is an anti-neoplastic agent that has a potential to be used in multiple malignancies.

scholarly journals Association Between HLA genotypes and Oxcarbazepine-induced Cutaneous Adverse Drug Reactions: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 21 (1) ◽  
pp. 1 ◽  
Author(s):  
Wimonchat Tangamornsuksan ◽  
Norman Scholfield ◽  
Manupat Lohinavy
Keyword(s):  
General Population ◽  
Adverse Drug Reactions ◽  
Meta Analysis ◽  
Maculopapular Rash ◽  
Cochrane Library ◽  
Stevens Johnson Syndrome ◽  
Drug Reactions ◽  
Johnson Syndrome ◽  
Hla Genotypes ◽  
General Populations

PURPOSE: To systematically review and quantitatively synthesize associations between HLA genotypes and oxcarbazepine-induced cutaneous adverse drug reactions (OXC-cADRs), including Stevens–Johnson syndrome (SJS) and maculopapular rash. METHODS: Studies investigating associations between HLA genotypes and OXC-cADRs were systematically searched irrespective of language, in PubMed, HuGENet (Human Genome Epidemiology Network), and the Cochrane Library from their inception until January, 2017. Inclusion criteria were studies investigating associations between HLA genotypes and OXC-cADRs that reported sufficient data for calculating the frequency of HLA genotype carriers among cases and controls. Overall odds ratios (ORs) with corresponding 95%CIs were calculated using a random-effects model to determine the association between HLA genotypes and OXC-cADRs.  RESULTS: The initial searches identified 91 articles, of which 6 studies met the selection criteria. The studies included 229 patients with OXC-cADRs, 251 OXC-tolerant patients, and 2,358 participants from general populations of Han Chinese, Korean, and Thai ethnicities.  Associations between HLA-B*1502 and OXC-induced SJS were found in both the general population [OR=30.2 (95%CI=3.45-264)] and in OXC-tolerant individuals [OR=26.4 (95%CI=7.98-87.6)]. An association between the HLA-B*1502 and OXC-induced maculopapular rash was found in the general population [OR=5.67 (95%CI=2.03-15.9)] while HLA-A*3101 also associated with OXC-induced maculopapular rash [overall OR=29.2 (95%CI=6.70-128)].  CONCLUSIONS: Strong associations between the HLA-B*1502 and OXC-cADRs (SJS and maculopapular rash) were found in both controls from general population and OXC-tolerant groups. There was also an association between HLA-B*3101 and OXC-induced maculopapular rash. For patient safety, genetic screening especially for HLA-B*1502 prior to OXC therapy at least in these closely related ethnicities is warranted. Further studies need to better define other ethnicities at risk and a wider range of MHC gene subtypes. This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

scholarly journals Mycoplasma Pneumoniae Associated with Stevens Johnson Syndrome

2007 ◽  
Vol 35 (3) ◽  
pp. 414-417 ◽  
Author(s):  
J. M. Mulvey ◽  
A. Padowitz ◽  
M. Lindley-Jones ◽  
R. Nickels
Keyword(s):  
Respiratory Failure ◽  
Mycoplasma Pneumoniae ◽  
Multiple Organ ◽  
Stevens Johnson Syndrome ◽  
Skin Reactions ◽  
Genital Ulceration ◽  
Johnson Syndrome ◽  
Organ Systems ◽  
Prolonged Ventilation ◽  
Tract Involvement

We describe a case of Mycoplasma pneumoniae chest infection associated with Stevens Johnson syndrome. The patient had extensive epidermal bullous vesicles, oropharyngeal and genital ulceration and required prolonged ventilation due to respiratory failure. Mycoplasma pneumoniae infections are often asymptomatic but can involve multiple organ systems. Respiratory tract involvement is generally benign though 3 to 10% of patients develop clinical pneumonia. Secondary skin reactions are common (20 to 25%), although few patients infected develop Stevens Johnson syndrome. It has been suggested that Mycoplasma pneumoniae may be the most common infectious cause of Stevens Johnson syndrome.

scholarly journals Commercial Cannabinoid Oil-Induced Stevens-Johnson Syndrome

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Han Y. Yin ◽  
Nicholas Hadjokas ◽  
Kanish Mirchia ◽  
Robert Swan ◽  
Samuel Alpert
Keyword(s):  
Total Body Surface Area ◽  
Supportive Therapy ◽  
Maculopapular Rash ◽  
Acute Onset ◽  
Stevens Johnson Syndrome ◽  
Drug Reactions ◽  
Drug Induced ◽  
Johnson Syndrome ◽  
Eye Involvement ◽  
Total Body

Purpose. To report an unusual presentation of commercial cannabidiol (CBD) oil-induced Stevens-Johnson Syndrome/toxic epidermal necrolysis (SJS-TEN). Methods. A 56-year-old woman presented with acute onset of a diffuse, blistering, maculopapular rash with over 30% total body surface area (BSA) involvement two days after taking CBD oil sublingually for chronic pain. Biopsy confirmed SJS-TEN. Ophthalmology was consulted and mild eye involvement was found. She was started on topical cyclosporine, prednisone, moxifloxacin, and erythromycin ointment to prevent progression, which was successful. She was otherwise treated with supportive therapy in the intensive care burn unit and ultimately passed away from septic shock. Conclusion. In this case, we described an unusual drug-induced SJS from a commercial, non-FDA-regulated cannabis product. The use of a commercial CBD product should be cautioned due to potential for series of drug reactions to the cannabis product and the risk for reaction to other unregulated other pharmacological components.

scholarly journals Severe pneumonia leading to death in an achondroplasic infant: a rare case report

2018 ◽  
Vol 5 (2) ◽  
pp. 681
Author(s):  
Mankiran K. Matharoo ◽  
Gursharn S. Narang
Keyword(s):  
Case Report ◽  
Rare Case ◽  
Respiratory Infections ◽  
Cardiopulmonary Arrest ◽  
Multiorgan Failure ◽  
Failure To Thrive ◽  
Severe Pneumonia ◽  
Severe Respiratory Distress ◽  
Rare Case Report ◽  
History Of

This report concerns a 9-month-old male with achondroplasia presenting with severe respiratory distress having history of frequent respiratory infections, developmental delay and failure to thrive. Child had septicemia and ended up in multiorgan failure, ultimately leading to death due to cardiopulmonary arrest.

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