Response to Modified Antitubercular Drug Regime and Antiretroviral Therapy in a Case of HIV Infection with Disseminated Tuberculosis with Isoniazid Induced Toxic Epidermal Necrolysis

Toxic epidermal necrolysis (TEN) is a potentially life-threatening disorder characterized by widespread erythema, necrosis, and bullous detachment of the epidermis and mucous membranes. Without proper management,TEN can cause sepsis leading to death of the patient. Though TEN is commonly drug induced, Isoniazid (INH) has been uncommonly associated with TEN. As INH is one of the first line drugs in treatment of tuberculosis, TEN induced INH needs modification of antitubercular therapy (ATT) with withdrawal of INH from the treatment regime along with other supportive treatments. Patients with HIV infection and disseminated tuberculosis need to be urgently initiated on an effective ATT on diagnosis of tuberculosis. However, if the patient develops potential life-threatening toxicity to first line antitubercular drugs like INH, an alternative effective ATT combination needs to be started as soon as the condition of the patient stabilizes as most of these patients present in advanced stage of HIV infection and this is to be followed by antiretroviral therapy (ART) as per guidelines. The present case reports the effectiveness of an ATT regime comprising Rifampicin, Pyrazinamide, Ethambutol, and Levofloxacin along with ART in situations where INH cannot be given in disseminated tuberculosis in HIV patients.

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Effect of concomitant HIV infection on adverse drug reactions by first line antitubercular drugs - a case series analysis

Journal of Ideas in Health ◽

10.47108/jidhealth.vol3.iss3.73 ◽

2020 ◽

Vol 3 (3) ◽

pp. 222-225

Author(s):

Alka Bansal ◽

Lokendra Sharma

Keyword(s):

Hiv Infection ◽

Adverse Drug Reactions ◽

Case Series ◽

Individual Case ◽

Drug Reactions ◽

First Line ◽

Drug Induced ◽

Antitubercular Drugs ◽

Cutaneous Reactions ◽

Recovery Status

The pattern and severity of adverse drug reactions (ADRs) due to first-line anti-tubercular drugs in solely tubercular and TB-HIV co-infected patients could be different due to drug-disease and drug-drug interactions in TB-HIV co-infected patients. Nevertheless, the studies regarding this aspect are very meager. Hence a retrospective appraisal of individual case safety reports (ICSR) due to first-line antitubercular drugs spontaneously submitted to the ADR monitoring center was done for solely tubercular and TB-HIV coinfected patients. Out of eight ICSRs, four had concomitant HIV infection, and two of them were on antiretroviral (ARV) drugs. Co-infected patients showed rare and severe ADRs like optic neuritis, acute renal failure, and drug-induced liver injury (DILI). In contrast, four non-HIV co-infected tubercular patients suffered from comparatively less severe cutaneous reactions and vertigo. A high negative (-0.774) correlation coefficient between HIV co-infection and recovery status found that HIV co-infected patients had low chances of fully recovering. In conclusion, HIV co-infection and ARV drugs can affect the pattern, severity, and recovery status of adverse drug reactions due to first-line antitubercular drugs.

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Stevens - Johnson Syndrome and Toxic Epidermal Necrolysis; Extensive Review of Reports of Drug-Induced Etiologies, and Possible Therapeutic Modalities

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2018.148 ◽

2018 ◽

Vol 6 (4) ◽

pp. 730-738 ◽

Cited By ~ 8

Author(s):

Adegbenro Omotuyi John Fakoya ◽

Princess Omenyi ◽

Precious Anthony ◽

Favour Anthony ◽

Precious Etti ◽

...

Keyword(s):

Adverse Drug Reaction ◽

Toxic Epidermal Necrolysis ◽

Stevens Johnson Syndrome ◽

Hypersensitivity Reactions ◽

Extensive Review ◽

Drug Induced ◽

Therapeutic Modalities ◽

Johnson Syndrome ◽

Mucous Membranes ◽

Degrees Of Severity

Stevens - Johnson Syndrome and Toxic Epidermal Necrolysis are adverse hypersensitivity reactions that affect the skin and mucous membranes. They are characterised by erythematous macules and hemorrhagic erosions of the mucous membranes. Epidermal detachments of varying degrees of severity also occur in these conditions. Various aetiologies are associated with these conditions, with adverse drug reaction being the most common. Though the worldwide incidence of these conditions is recorded as low, diverse types of medication are being observed to lead to these conditions. This review compiles information on the details of Stevens-Johnson syndrome and Toxic Epidermal Necrolysis, the pathophysiology, therapeutic management, and largely considers the drug-induced etiologies associated with these conditions.

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Toxic epidermal necrolysis

F1000Research ◽

10.12688/f1000research.7574.1 ◽

2016 ◽

Vol 5 ◽

pp. 951 ◽

Cited By ~ 10

Author(s):

Wolfram Hoetzenecker ◽

Tarun Mehra ◽

Ieva Saulite ◽

Martin Glatz ◽

Peter Schmid-Grendelmeier ◽

...

Keyword(s):

Cell Death ◽

Mortality Rate ◽

Toxic Epidermal Necrolysis ◽

Human Leukocyte ◽

Best Supportive Care ◽

Drug Induced ◽

Leukocyte Antigen ◽

Mucosal Involvement ◽

Keratinocyte Cell ◽

Life Threatening

Toxic epidermal necrolysis (TEN) is a rare, life-threatening drug-induced skin disease with a mortality rate of approximately 30%. The clinical hallmark of TEN is a marked skin detachment caused by extensive keratinocyte cell death associated with mucosal involvement. The exact pathogenic mechanism of TEN is still uncertain. Recent advances in this field have led to the identification of several factors that might contribute to the induction of excessive apoptosis of keratinocytes. In addition, specific human leukocyte antigen types seem to be associated with certain drugs and the development of TEN. As well-controlled studies are lacking, patients are treated with various immunomodulators (e.g. intravenous immunoglobulin) in addition to the best supportive care.

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A case of nimesulide induced toxic epidermal necrolysis

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20201764 ◽

2020 ◽

Vol 9 (5) ◽

pp. 810

Author(s):

Suja Xaviar ◽

Mirunalini Ravichandran

Keyword(s):

Mortality Rate ◽

Toxic Epidermal Necrolysis ◽

Skin Disease ◽

The Body ◽

Drug Induced ◽

Over The Counter ◽

Life Threatening ◽

Cox 2 ◽

Adequate Management ◽

Possible Cause

Toxic epidermal necrolysis (TEN) is a rare life-threatening drug-induced mucocutaneous skin disease with a mortality rate of approximately 30%. Nimesulide is a preferential cyclo-oxygenase (COX-2) inhibitor which is frequently used for its antipyretic, anti-inflammatory and analgesic activity. Here, we report a case of nimesulide induced toxic epidermal necrolysis in a 57 years old male patient. This patient was admitted in the hospital with symptoms of epidermal sloughing and fluid filled blisters all over the body following over the counter intake of nimesulide for fever. The drug was promptly stopped, and patient was managed with steroids, antibiotics and other adequate supportive measures. The patient showed significant recovery following stoppage of drug and adequate management. This case highlights the importance of nimesulide and other NSAIDs as possible cause of TEN.

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Clinical spectrum and severity of hemolytic anemia in glucose 6-phosphate dehydrogenase–deficient children receiving dapsone

Blood ◽

10.1182/blood-2012-03-416032 ◽

2012 ◽

Vol 120 (20) ◽

pp. 4123-4133 ◽

Cited By ~ 60

Author(s):

Allan Pamba ◽

Naomi D. Richardson ◽

Nick Carter ◽

Stephan Duparc ◽

Zul Premji ◽

...

Keyword(s):

Blood Transfusion ◽

Hemolytic Anemia ◽

G6pd Deficiency ◽

Case Reports ◽

Drug Induced ◽

Once Daily ◽

Maximum Decrease ◽

Life Threatening ◽

The Mean ◽

Glucose 6 Phosphate Dehydrogenase

AbstractDrug-induced acute hemolytic anemia led to the discovery of G6PD deficiency. However, most clinical data are from isolated case reports. In 2 clinical trials of antimalarial preparations containing dapsone (4,4′-diaminodiphenylsulfone; 2.5 mg/kg once daily for 3 days), 95 G6PD-deficient hemizygous boys, 24 G6PD-deficient homozygous girls, and 200 girls heterozygous for G6PD deficiency received this agent. In the first 2 groups, there was a maximum decrease in hemoglobin averaging −2.64 g/dL (range −6.70 to +0.30 g/dL), which was significantly greater than for the comparator group receiving artemether-lumefantrine (adjusted difference −1.46 g/dL; 95% confidence interval −1.76, −1.15). Hemoglobin concentrations were decreased by ≥ 40% versus pretreatment in 24/119 (20.2%) of the G6PD-deficient children; 13/119 (10.9%) required blood transfusion. In the heterozygous girls, the mean maximum decrease in hemoglobin was −1.83 g/dL (range +0.90 to −5.20 g/dL); 1 in 200 (0.5%) required blood transfusion. All children eventually recovered. All the G6PD-deficient children had the G6PD A− variant, ie, mutations V68M and N126D. Drug-induced acute hemolytic anemia in G6PD A− subjects can be life-threatening, depending on the nature and dosage of the drug trigger. Therefore, contrary to current perception, in clinical terms the A− type of G6PD deficiency cannot be regarded as mild. This study is registered at http://www.clinicaltrials.gov as NCT00344006 and NCT00371735.

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Solifenacin-induced acute urticaria and angioedema: a rare adverse effect

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2020-138375 ◽

2021 ◽

pp. postgradmedj-2020-138375

Author(s):

Umer Younas ◽

Omar Shafiq ◽

Sahibzada Nasir Mansoor ◽

Muhammad Tawab Khalil

Keyword(s):

Adverse Effect ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Complete Resolution ◽

Case Reports ◽

Temporal Association ◽

First Line ◽

Drug Induced ◽

Acute Urticaria ◽

Cord Injury

Antimuscarinics are first-line medication for management of overactive bladder with solifenacin being commonly prescribed. Angioedema is the swelling of mucosa and submucosal tissue. There are no published case reports of drug-induced angioedema involving solifenacin. We report a case of a 41-year-old man with spinal cord injury who presented with oedema of face, lips, tongue and associated pruritic urticaria after taking 5 mg of solifenacin. All other possible causes including food allergy, insect bite, hereditary angioedema, use of NSAIDs, ACE inhibitors and antibiotics were ruled out. The temporal association between solifenacin and angioedema and complete resolution of symptoms after discontinuing the drug suggest that solifenacin was the most probable cause of angioedema in our patient.

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Cost-Effectiveness of Lopinavir/Ritonavir Versus Nelfinavir As the First-Line Highly Active Antiretroviral Therapy Regimen for HIV Infection

HIV Clinical Trials ◽

10.1310/wt81-mem4-5c4l-chpk ◽

2004 ◽

Vol 5 (5) ◽

pp. 294-304 ◽

Cited By ~ 46

Author(s):

Kit N. Simpson ◽

Michelle P. Luo ◽

Elinor Chumney ◽

Eugene Sun ◽

Scott Brun ◽

...

Keyword(s):

Cost Effectiveness ◽

Antiretroviral Therapy ◽

Hiv Infection ◽

Highly Active Antiretroviral Therapy ◽

First Line ◽

Therapy Regimen ◽

Highly Active

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A Cautionary Tale of Etanercept Use in Patients With Toxic Epidermal Necrolysis

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa194 ◽

2020 ◽

Author(s):

Janie Faris ◽

Jordan Wilson ◽

Heather S Dolman ◽

Andrew Isaacson ◽

Alfred E Baylor ◽

...

Keyword(s):

Toxic Epidermal Necrolysis ◽

Case Reports ◽

The United States ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Cautionary Tale ◽

Life Threatening ◽

Positive Results ◽

Severe Cutaneous Reaction ◽

Necrosis Factor

Abstract Toxic epidermal necrolysis (TEN) is a severe cutaneous reaction that can be life-threatening. In the United States, there are no established guidelines for the treatment of TEN. Supportive care including fluids and supportive therapies are the current recommendations. Research surrounding TEN involves mostly case studies or small, uncontrolled studies. Recent literature describes the use of tumor necrosis factor blockers in the treatment of TEN with positive results. These case reports describe decreased time to reepithelization, hospital length of stay, and minimal side effects. Conversely, we present three fatalities after the administration of etanercept.

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