Warfarin-induced toxic epidermal necrolysis after mitral valve replacement

2020 ◽  
Vol 28 (9) ◽  
pp. 601-603
Author(s):  
Taiyo Kuroda ◽  
Yukifusa Yokoyama ◽  
Masao Yamada ◽  
Satoshi Yuhara ◽  
Hiroki Hasegawa ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Toxic Epidermal Necrolysis ◽  
Drug Hypersensitivity ◽  
Lymphocyte Transformation ◽  
Lymphocyte Transformation Test ◽  
Stevens Johnson Syndrome ◽  
Valve Prosthesis ◽  
Mitral Valve Prosthesis ◽  
Johnson Syndrome ◽  
Mucous Membranes

Stevens-Johnson syndrome and toxic epidermal necrolysis are rare diseases that cause acute destruction of the epithelium of the skin and mucous membranes, almost always attributable to drugs. However, warfarin-induced Stevens-Johnson syndrome and toxic epidermal necrolysis is extremely rare. We report the case of 71-year-old woman who died due to destructive erosion all over her skin and mucous membranes. She had received a mitral valve prosthesis, and warfarin was prescribed for antithrombotic therapy. A lymphocyte transformation test for drug hypersensitivity and the clinical history confirmed this phenomenon as warfarin-induced toxic epidermal necrolysis.

Assessment of drug causality in Stevens‐Johnson syndrome/toxic epidermal necrolysis: Concordance between lymphocyte transformation test and ALDEN

Allergy ◽  
2019 ◽  
Vol 75 (4) ◽  
pp. 956-959 ◽  
Author(s):  
Teresa Bellón ◽  
Sara Rodríguez‐Martín ◽  
Rosario Cabañas ◽  
Elena Ramírez ◽  
Victoria Lerma ◽  
...  
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Lymphocyte Transformation ◽  
Lymphocyte Transformation Test ◽  
Stevens Johnson Syndrome ◽  
Johnson Syndrome

scholarly journals Current Pharmacogenetic Perspective on Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Lin Cheng
Keyword(s):  
T Cell ◽  
Toxic Epidermal Necrolysis ◽  
Ex Vivo ◽  
Lymphocyte Transformation ◽  
Lymphocyte Transformation Test ◽  
Stevens Johnson Syndrome ◽  
Public Health Issue ◽  
Johnson Syndrome ◽  
Efficacious Treatment ◽  
The Common

Adverse drug reactions are a public health issue that draws widespread attention, especially for Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) which have high mortality and lack of efficacious treatment. Though T-cell-mediated HLA-interacted immune response has been extensively studied, our understanding of the mechanism is far from satisfactory. This review summarizes infection (virus, bacterial, and mycoplasma infection), an environmental risk factor, as a trigger for SJS/TEN. The mutations or polymorphisms of drug metabolic enzymes, transporters, receptors, the immune system genes, and T-cell-mediated apoptosis signaling pathways that contribute to SJS/TEN are discussed and summarized. Epigenetics, metabolites, and mobilization of regulatory T cells and tolerogenic myeloid precursors are emerged directions to study SJS/TEN. Ex vivo lymphocyte transformation test has been exploited to aid in identifying the causative drugs. Critical questions on the pathogenesis of SJS/TEN underlying gene polymorphisms and T cell cytotoxicity remain: why some of the patients carrying the risky genes tolerate the drug and do not develop SJS/TEN? What makes the skin and mucous membrane so special to be targeted? Do they relate to skin/mucous expression of transporters? What is the common machinery underlying different HLA-B alleles associated with SJS/TEN and common metabolites?

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

2018 ◽  
Vol 6 (4) ◽  
pp. 730-738 ◽  
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.

Head and Neck Manifestations of Erythema Multiforme in Children

1994 ◽  
Vol 111 (3P1) ◽  
pp. 236-242 ◽  
Author(s):  
Michael G. Stewart ◽  
Newton O. Duncan ◽  
Daniel J. Franklin ◽  
Ellen M. Friedman ◽  
Marcelle Sulek
Keyword(s):  
Oral Cavity ◽  
Toxic Epidermal Necrolysis ◽  
Head And Neck ◽  
Erythema Multiforme ◽  
Medication Use ◽  
Stevens Johnson Syndrome ◽  
Striking Increase ◽  
Johnson Syndrome ◽  
Mucosal Involvement ◽  
Mucous Membranes

Erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis are related disorders of skin and mucous membranes, which are typically associated with antecedent medication use or infection. We review 108 cases of erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis from Texas Children's Hospital, Houston, Texas, from 1981 to 1991, and illustrate the characteristic skin and mucosal lesions. In addition, we describe in detail two unusual cases requiring intensive airway management. Head and neck manifestations were present in 4 of 79 patients (5%) with erythema multiforme and 26 of 28 patients (93%) with Stevens-Johnson syndrome. In Stevens-Johnson syndrome, mucosal involvement of the lip (93%), conjunctiva (82%), oral cavity (79%), and nose (36%) were most common. Antecedent medication use was identified in 59% of erythema multiforme patients and 68% of Stevens-Johnson syndrome patients. We note a striking increase in the number of cases in our series caused by cephalosporins. Fifty percent of Stevens-Johnson syndrome patients required supplemental hydration or alimentation because of the severity of the oral cavity involvement. The head and neck mucosal manifestations largely respond to local care, and the routine use of prophylactic antibiotics or systemic steroids is not recommended.

scholarly journals A rare case of toxic epidermal necrolysis in pregnancy

2020 ◽  
Vol 9 (2) ◽  
pp. 846
Author(s):  
Reena Yadav ◽  
Astha Srivastava ◽  
Preeti Pawar ◽  
Vibhu Mendiratta ◽  
Prerna Tayal
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Perinatal Outcome ◽  
Rare Case ◽  
Rare Condition ◽  
Stevens Johnson Syndrome ◽  
Successful Pregnancy ◽  
Johnson Syndrome ◽  
Mucous Membranes ◽  
Epidermal Necrosis ◽  
In Pregnancy

Stevens-Johnson syndrome (SJS) is a group of toxic necrolytic group of disorder of skin and mucous membrane with significant morbidity and mortality. It is a highly serious allergic reaction to medications affecting the skin and mucous membranes. Pregnant women with SJS or toxic epidermal necrolysis (TEN) are a unique subset, and both conditions can simultaneously affect the mother and fetus. It is a rare condition with a reported incidence of one case per million people per year. Till date, few cases of pregnancy with SJS/TEN have been reported. We are reporting a case of 20-year-old primigravida with 31+3 weeks of gestation presenting with extensive toxic epidermal necrosis. Attack of SJS developing in pregnancy can be fatal because immunity is compromised. This patient was managed in our institute with involvement of multidisciplinary team and had a successful pregnancy outcome. Perinatal outcome was also good in this case.

scholarly journals A case report of Stevens-Johnson syndrome and toxic epidermal necrolysis due to diclofenac sodium

2020 ◽  
Vol 9 (7) ◽  
pp. 1132
Author(s):  
Sreenivasa Rao Bendi ◽  
Tarun Kumar Suvvari
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Diclofenac Sodium ◽  
Skin Surface ◽  
Severe Form ◽  
Stevens Johnson Syndrome ◽  
Phenyl Acetic Acid ◽  
Disease Spectrum ◽  
Johnson Syndrome ◽  
Mucous Membranes ◽  
Severe Skin Reaction

Stevens-Johnson syndrome (SJS) is a severe skin reaction most often triggered by particular drugs in most of the cases. A more severe form of the condition is called toxic epidermal necrolysis (TEN) which involves more than 30% of the skin surface and extensive damage to the mucous membranes. SJS and TEN previously were thought to be separate conditions, but they are now considered part of a disease spectrum. The main drugs which induce SJS were anti-gout drugs, anti-epileptics, analgesics, NSAIDs and antibiotics. Diclofenac which is a NSAID and phenyl acetic acid derivative that rarely causes SJS. Although diclofenac induced Stevens-Johnson syndrome is reported very rare among adults, it shouldn’t be neglected. In this report we mentioned about the Stevens-Johnson syndrome (SJS) which was later developed into TEN due to usage diclofenac sodium, in a 65 years old female patient.

scholarly journals Carbamazepine Induces Focused T Cell Responses in Resolved Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Cases But Does Not Perturb the Immunopeptidome for T Cell Recognition

2021 ◽  
Vol 12 ◽  
Author(s):  
Nicole A. Mifsud ◽  
Patricia T. Illing ◽  
Jeffrey W. Lai ◽  
Heidi Fettke ◽  
Luca Hensen ◽  
...  
Keyword(s):  
T Cells ◽  
T Cell ◽  
Toxic Epidermal Necrolysis ◽  
Drug Hypersensitivity ◽  
Stevens Johnson Syndrome ◽  
Hypersensitivity Reactions ◽  
Memory T Cell ◽  
Cell Pool ◽  
Johnson Syndrome ◽  
Drug Hypersensitivity Reactions

Antiseizure medications (ASMs) are frequently implicated in T cell-mediated drug hypersensitivity reactions and cause skin tropic pathologies that range in severity from mild rashes to life-threatening systemic syndromes. During the acute stages of the more severe manifestations of these reactions, drug responsive proinflammatory CD8+ T cells display classical features of Th1 cytokine production (e.g. IFNγ) and cytolysis (e.g. granzyme B, perforin). These T cells may be found locally at the site of pathology (e.g. blister cells/fluid), as well as systemically (e.g. blood, organs). What is less understood are the long-lived immunological effects of the memory T cell pool following T cell-mediated drug hypersensitivity reactions. In this study, we examine the ASM carbamazepine (CBZ) and the CBZ-reactive memory T cell pool in patients who have a history of either Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) from 3-to-20 years following their initial adverse reaction. We show that in vitro drug restimulation of CBZ-reactive CD8+ T cells results in a proinflammatory profile and produces a mainly focused, yet private, T cell receptor (TCR) usage amongst human leukocyte antigen (HLA)-B*15:02-positive SJS or TEN patients. Additionally, we show that expression of these CBZ-reactive TCRs in a reporter cell line, lacking endogenous αβTCR, recapitulates the features of TCR activation reported for ASM-treated T cell lines/clones, providing a useful tool for further functional validations. Finally, we conduct a comprehensive evaluation of the HLA-B*15:02 immunopeptidome following ASM (or a metabolite) treatment of a HLA-B*15:02-positive B-lymphoblastoid cell line (C1R.B*15:02) and minor perturbation of the peptide repertoire. Collectively, this study shows that the CBZ-reactive T cells characterized require both the drug and HLA-B*15:02 for activation and that reactivation of memory T cells from blood results in a focused private TCR profile in patients with resolved disease.

scholarly journals A case report of toxic epidermal necrolysis (TEN) in a patient with COVID-19 treated with hydroxychloroquine: are these two partners in crime?

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Carlo Maria Rossi ◽  
Flavio Niccolò Beretta ◽  
Grazia Traverso ◽  
Sandro Mancarella ◽  
Davide Zenoni
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Fatal Outcome ◽  
Total Body Surface Area ◽  
Stevens Johnson Syndrome ◽  
First Case ◽  
Cutaneous Adverse Reaction ◽  
Johnson Syndrome ◽  
Mucous Membranes ◽  
Total Body ◽  
The Moment

Abstract Background Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) is the most Serious Cutaneous Adverse Reaction (SCAR) often with a fatal outcome. Coronavirus Disease (COVID-19) is caused by Severe Acute Respiratory Syndrome–Coronavirus—2 (SARS-COV2) and is an emergent pandemic for which no cure exist at the moment. Several drugs have been tried often with scant clinical evidence and safety. Case presentation Here we report the case of 78-years-old woman with cardiometabolic syndrome and COVID-19. A multidrug regimen including others hydroxychloroquine, antibiotics, dexamethasone and paracetamol, low-molecular-weight-heparin and potassium canrenoate was started. After almost 3 weeks, the patient started to display a violaceous rash initially involving the flexural folds atypical targetoid lesions and showing a very fast extension, blister formation and skin detachments of approximately 70% of the total body surface area and mucous membranes involvement consistent with toxic epidermal necrolysis (TEN). The ALDEN algorithm was calculated inserting all drugs given to the patient in the 28 days preceding the onset of the skin manifestations. The highest score retrieved was for hydroxychloroquine. Other less suspicious drugs were piperacillin/tazobactam, ceftriaxone and levofloxacin. Conclusions To our knowledge, this is the first case of TEN in a patient suffering from COVID-19 probably associated with hydroxychloroquine. Given the activation of the immune system syndrome induced by the virus and the widespread off-label use of this drug, we suggest a careful monitoring of skin and mucous membranes in all COVID-19 positive patients treated with hydroxychloroquine in order to early detect early signs of toxicities.

scholarly journals The Importance of Accurate Anamnesis in Determining Suspected Drugs Causing of Oral Manifestation of Stevens Johnson Syndrome-Toxic Epidermal Necrolysis (Case Report)

2017 ◽  
Vol 1 ◽  
Author(s):  
Selvia Selvia ◽  
Indriasti I Wardhany
Keyword(s):  
Case Report ◽  
Toxic Epidermal Necrolysis ◽  
Information Gain ◽  
Drug Hypersensitivity ◽  
Critical Role ◽  
Stevens Johnson Syndrome ◽  
Sufficient Information ◽  
Oral Medicine ◽  
Oral Manifestation ◽  
Johnson Syndrome

<p class="AbstractContent"><strong>Introduction</strong>: Stevens - Johnson Syndrome (SJS) and Toxic epidermal necrolysis (TEN) are drug hypersensitivity life-threatening disease that involve skin and mucous membrane. Oral manifestation occurs in almost all the patients of SJS-TEN.</p><p class="AbstractContent"><strong>Case report:</strong> A 52-years-old SJS-TEN female patient was referred from department of dermatology and venereology of RSCM hospital, Jakarta to the department of oral medicine, because of the painful ulcers in the mouth and difficulty to eat. Severe loss of integrity lesions was found in lips and oral mucosa. The causing drugs cannot be identified earlier because of challenging condition during anamnesis. The leading clue of suspected causative drugs was conducted by oral medicine specialist with in depth anamnesis of thorough patients’ medical history. Allergic test after six-week period after the patient first visit shows positive result of carbamazepine and amitriptyline hypersensitivity.</p><p class="AbstractContent"><strong>Discussion</strong>: The delayed in determining causing drugs in this case were because of several causes, especially lack of information gain during anamnesis. In the condition when the operator cannot obtain sufficient information due to patient condition, it was very important to have an excellent communication in the collaborating medical team and patient family as well as constantly obtaining new important information during the ongoing treatment. Since the appropriate and successful treatment was depending in determining an exact cause, the anamnesis plays a critical role in this case.</p><p class="AbstractContent"><strong>Conclusion:</strong> Accurate anamnesis by operator was an important part regarding the successful management of patient with SJS-TEN since the disease has an enormous impact in patient’s quality of life.</p>

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