Important Role of Prodromal Viral Infections Responsible for Inhibition of Xenobiotic Metabolizing Enzymes in the Pathomechanism of Idiopathic Reye's Syndrome, Stevens-Johnson Syndrome, Autoimmune Hepatitis, and Hepatotoxicity of the Therapeutic Doses of Acetaminophen Used in Genetically Predisposed Persons

Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are Severe Cutaneous Adverse Reactions (SCARS) characterized by fever and mucocutaneous lesions leading to necrosis and sloughing of the epidermis. Conjunctival lesions are reported in 85% of patients. The pathogenesis of SJS/TEN/SCARS is not completely understood. It is hypothesized that IL-13, IL-15 and Granulysin expressed in plasma and skin may play a role. We measured the circulating levels of these cytokines in the plasma using ELISA and their expression in the skin using immunofluorescence microscopy. A total of 12 SJS/TEN skin biopsy samples (8 SJS, 2 SJS/TEN overlap and 2 TEN) were analyzed. Biopsy samples from patients with Lichen Planus (an inflammatory condition of the skin and mucous membranes) served as controls. Studies were also performed in human corneal epithelial cells where expression of these cytokines were measured following a challenge with TNF-α (0, 1, 10 and 100 ng/ml). The intensity of immunofluorescence was measured Using Imaris® software. The results showed significantly increased expression of these cytokines in the skin biopsy samples as measured by the average intensities of IL-13 (6.1 x 133.0 ± 4.231 x 10^8), and Granulysin (4.2 x 123.0 ± 4.231 x 10^8) compared to Lichen planus control (3.0 x 123.0 ±1.62 x 10^5). Increased expression of IL-13 and IL-15 were noted in cell culture studies and in the plasma samples when compared to Normal Human Plasma as controls. It is concluded that IL-13, IL-15 and Granulysin play a role in the pathogenesis of SJS/TEN.

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Phenytoin induced Steven Johnson syndrome

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11i1.1803 ◽

2020 ◽

Vol 11 (1) ◽

pp. 173-175 ◽

Cited By ~ 1

Author(s):

Naga Subrahmanyam S ◽

Nagaraju G V ◽

Tagoore Vijaya Lakshmi D

Keyword(s):

Health Care Professionals ◽

Rating Scale ◽

Viral Infections ◽

Causality Assessment ◽

Seizure Activity ◽

Stevens Johnson Syndrome ◽

Effective Management ◽

Neuronal Membranes ◽

Johnson Syndrome ◽

Steven Johnson Syndrome

Phenytoin is an anticonvulsant and Hydantoin, it is mainly used in the management o Seizures, and it stabilizes the neuronal membranes and decreases seizure activity by increasing efflux or reducing the influx of sodium ions across cell membranes in the motor cortex during the generation of nerve impulses. It is available in the market in the form of oral and intravenous forms, a loading dose of Phenytoin for the management of seizures is 10-20 mg, divided into 2-3 doses. Stevens-Johnson syndrome is a rare and serious adverse effect of the skin along with the membranes of the mucous. It is caused by specific Drugs or Viral Infections. We have performed causality assessment by using the WHO and NARANJO'S ADR rating scale. It will seem, it is a Probable ADR, and severity assessed it confers a Type-A ADR, and it should be in Probably Preventable. So being a Reliable Clinical Pharmacist, we recommend to all health care professionals be aware of adverse drug reactions, and Desirable vigilance is necessitated toward safe and effective management for specific patients, strictly observe the patients in sequence anticipate Dangerous Adverse events.

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EXAMINING THE ROLE OF THE NITRIC OXID SYSTEM AS THE ESSENTIAL PATHOGENETIC LINK IN STEVENS-JOHNSON SYNDROME

Wiadomości Lekarskie ◽

10.36740/wlek202009202 ◽

2020 ◽

Vol 73 (9) ◽

pp. 1900-1903

Author(s):

Natalya V. Ivanyushko – Nazarko ◽

Оrysya О. Syzon ◽

Svitlana V. Volbyn ◽

Tetyana I. Rudnyk ◽

Marianna O. Dashko

Keyword(s):

Nitric Oxide ◽

Blood Serum ◽

Clinical Signs ◽

Oxide System ◽

Stevens Johnson Syndrome ◽

Nitrate Anion ◽

Johnson Syndrome ◽

Nitric Oxid ◽

Nitric Oxide System

, , , , The aim: To determine a possible role of nitric oxide system as one of the pathogenesis links in Stevens-Johnson syndrome depending on the severity of disease progression. Material and methods: We examined 11 patients with Stevens-Johnson syndrome. The function of nitric oxide system (NO - NOS) in blood serum was examined. Results: During the study of nitric oxide system (NO-NOS) in patients with SJS, it was observed that NO2¯ level was increased by 1.53 times, NO3¯ level – by 3.33 times, activity of total NOS – by 5.78 times, constitutive (cNOS) – by 1.81 times and inducible (iNOS) – by 13.36 times. Conclusions: The intensity of nitric oxide system function was studied in patients with Stevens-Johnson syndrome and dependence of changes of its parameters from the clinical signs of disease was detected. It was found that the determination of nitrite and nitrate anion levels in blood serum can be used for the purpose of predicting the disease course and choosing the therapy methods for the patients with SJS.

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Recent Updates in the Treatment of Erythema Multiforme

Medicina ◽

10.3390/medicina57090921 ◽

2021 ◽

Vol 57 (9) ◽

pp. 921

Author(s):

Alexa Soares ◽

Olayemi Sokumbi

Keyword(s):

Erythema Multiforme ◽

Viral Infections ◽

Immunosuppressive Agents ◽

Symptomatic Treatment ◽

Stevens Johnson Syndrome ◽

Topical Steroids ◽

Johnson Syndrome ◽

Mucosal Involvement ◽

Simplex Virus ◽

Antiviral Medications

Erythema multiforme (EM) is an immune-mediated condition that classically presents with discrete targetoid lesions and can involve both mucosal and cutaneous sites. While EM is typically preceded by viral infections, most notably herpes simplex virus (HSV), and certain medications, a large portion of cases are due to an unidentifiable cause. EM can be confused with other more serious conditions like Stevens–Johnson syndrome (SJS); however, clinical research has provided significant evidence to classify EM and SJS as separate disorders. Treatment of EM is highly variable, depending on the etiology, the involvement of mucosal sites, and the chronicity (acute vs. recurring) of the disease. If the etiology or causal medication/infection is identified, then the medication is stopped and/or the infection is treated prior to initiating symptomatic treatment. Treatment for acute EM is focused on relieving symptoms with topical steroids or antihistamines. Treatment for recurrent EM is most successful when tailored to individual patients. First line treatment for recurrent EM includes both systemic and topical therapies. Systemic therapies include corticosteroid therapy and antiviral prophylaxis. Topical therapies include high-potency corticosteroids, and antiseptic or anesthetic solutions for mucosal involvement. Second-line therapies for patients who do not respond to antiviral medications include immunosuppressive agents, antibiotics, anthelmintics, and antimalarials

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