Stevens-Johnson-Type Reaction with Vancomycin Treatment

1992 ◽  
Vol 26 (12) ◽  
pp. 1520-1521 ◽  
Author(s):  
Cato T. Laurencin ◽  
Richard F. Horan ◽  
Patrick B. Senatus ◽  
Clara B. Wheeler ◽  
Stephen J. Lipson
Keyword(s):  
Rheumatoid Arthritis ◽  
Causative Agent ◽  
Mortality Rates ◽  
Stevens Johnson Syndrome ◽  
Cervical Fusion ◽  
Case Summary ◽  
Johnson Syndrome ◽  
Fusion Site ◽  
Cutaneous Reactions ◽  
Vancomycin Treatment

OBJECTIVE: To report a case of Stevens-Johnson syndrome caused by vancomycin. CASE SUMMARY: Stevens-Johnson syndrome is an acute mucocutaneous process characterized by epidermal and mucosal desquamation. Its pathogenesis is poorly understood. Mortality rates have ranged from 30 to 100 percent. We describe a case of Stevens-Johnson syndrome related to the use of vancomycin in a 71-year-old woman with rheumatoid arthritis receiving treatment for an infected cervical fusion site. Classic “target” lesions distributed throughout the trunk and extremities along with erosive lesions involving the oral and vaginal mucosae were observed in this patient. DISCUSSION: A number of agents have been implicated in the etiology of Stevens-Johnson syndrome. Serious cutaneous reactions to vancomycin, however, have been uncommon. Cessation of vancomycin treatment in our patient led to eventual resolution of her symptoms. CONCLUSIONS: Vancomycin is a potential causative agent of Stevens-Johnson syndrome.

Stevens-Johnson syndrome complicating adalimumab therapy in rheumatoid arthritis disease

2011 ◽  
Vol 33 (5) ◽  
pp. 1351-1353 ◽  
Author(s):  
Aziza Mounach ◽  
Asmae Rezqi ◽  
Abderrazak Nouijai ◽  
Imad Ghozlani ◽  
Lahsen Achemlal ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Stevens Johnson Syndrome ◽  
Rheumatoid Arthritis Disease ◽  
Johnson Syndrome ◽  
Adalimumab Therapy

Possible Cefotaxime-Induced Stevens–Johnson Syndrome

2003 ◽  
Vol 37 (6) ◽  
pp. 812-814 ◽  
Author(s):  
Evagelos N Liberopoulos ◽  
George L Liamis ◽  
Moses S Elisaf
Keyword(s):  
Case Control Study ◽  
Causality Assessment ◽  
Clinical Manifestations ◽  
Underlying Mechanism ◽  
Upper Urinary Tract ◽  
Stevens Johnson Syndrome ◽  
Case Summary ◽  
Johnson Syndrome ◽  
Increased Risk ◽  
Control Study

OBJECTIVE: To report a case of possible cefotaxime-induced Stevens–Johnson syndrome (SJS). CASE SUMMARY: A 72-year-old woman with an upper urinary tract infection developed erosions and blisters on the skin and the mucous membranes, as well as fever and prostration, soon after the administration of cefotaxime. This presentation is consistent with the features of SJS. Resolution of the clinical manifestations was observed after discontinuation of the drug; all other drugs, infections, or immunologic disorders that could have caused this syndrome were carefully excluded. An objective causality assessment revealed that SJS was possibly associated with the use of cefotaxime. DISCUSSION: Although cephalosporins have been associated with an increased risk for SJS and cefotaxime has been suspected of being associated with SJS in a previous case–control study, this is the first full report for cefotaxime-related SJS in the literature. An immunologically mediated reaction may be the underlying mechanism. CONCLUSIONS: Although cefotaxime administration seems to be the underlying cause of the SJS observed in our patient, establishment of a definite causal relationship requires additional cases and supportive data.

scholarly journals Recent Dermatological Treatments for Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Japan

2021 ◽  
Vol 8 ◽  
Author(s):  
Ming-Hsiu Hsieh ◽  
Tomoya Watanabe ◽  
Michiko Aihara
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Ivig Therapy ◽  
Japanese Patients ◽  
Mortality Rates ◽  
Pulse Therapy ◽  
Stevens Johnson Syndrome ◽  
High Dose ◽  
Methylprednisolone Pulse ◽  
Johnson Syndrome ◽  
Additional Therapy

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are serious conditions characterized by necrosis of the skin and mucus membranes, and are mainly caused by medication and infections. Although the exact pathomechanism of SJS/TEN remains unclear, keratinocyte death is thought to be triggered by immune reactions to these antigens. While there is no established therapy for SJS/TEN, corticosteroids and intravenous immunoglobulin (IVIG) have been utilized as immunomodulator. We previously conducted a study to evaluate the efficacy of IVIG therapy in Japanese patients with SJS/TEN. IVIG was administered at a dosage of 400 mg/kg/day for 5 consecutive days as an additional therapy with systemic steroids. Prompt amelioration was observed in seven of the eight patients. All patients survived without sequelae. Recently, we retrospectively analyzed 132 cases of SJS/TEN treated in our two hospitals. The mortality rates in the patients treated with methylprednisolone pulse were 0% (0/31) for SJS and 7.0% (3/43) for TEN, and 0% (0/10) in the TEN patients treated with methylprednisolone pulse in combination with IVIG. These results suggest that early treatment with high-dose steroids, including methylprednisolone pulse therapy, and IVIG together with corticosteroids are possible therapeutic options to improve the prognosis of SJS/TEN.

scholarly journals Stevens-Johnson syndrome and toxic epidermal necrolysis: a review

2019 ◽  
Vol 7 (6) ◽  
pp. 2470
Author(s):  
Rodrigo Banegas Ruiz ◽  
Alan I. Valderrama Treviño ◽  
Gómez Mendoza F. F. ◽  
Baca Domínguez C. R. ◽  
Campos Angulo G. ◽  
...  
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
B Lymphocytes ◽  
Body Surface ◽  
Cytotoxic T Cells ◽  
The Body ◽  
Stevens Johnson Syndrome ◽  
Johnson Syndrome ◽  
Diffuse Erythema ◽  
Cutaneous Reactions ◽  
Therapeutic Alternatives

Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are considered a single entity with variability in the extent of the lesions, characterized by erythema multiforme that may involve mucosa. Severe cutaneous reactions secondary to medications are classified according to the area of epidermal detachment. The activation of cytotoxic T cells and macrophages is mediated mainly by IL-2 and interferon gamma secreted by Th1 lymphocytes, and the activation of eosinophils and B lymphocytes in IgE is mediated by secreted IL-4, IL-5, IL-10 and IL13 by B lymphocytes. The topography of SJS is predominantly central, affecting the trunk and sometimes a generalized dissemination is shown that affects a body surface area of less than 10%, characterized by irregular violaceous erythematous macules of target shooting, which can form confluent blisters. TEN is characterized by a skin detachment greater than 30% of the body surface, whose predominant lesion is diffuse erythema with individual macules, which give rise to detachment surfaces greater than 5 cm. The treatment is symptomatic, nonspecific, and aimed at avoiding complications, carried out in specialized intensive care units, due to ignorance of the pathogenesis. Integral management with different therapeutic alternatives can represent a crucial part in the multisystemic management of SJS and TEN.

scholarly journals Association between HLA-B Alleles and Carbamazepine-Induced Maculopapular Exanthema and Severe Cutaneous Reactions in Thai Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Chonlaphat Sukasem ◽  
Chonlawat Chaichan ◽  
Thapanat Nakkrut ◽  
Patompong Satapornpong ◽  
Kanoot Jaruthamsophon ◽  
...  
Keyword(s):  
Case Control Study ◽  
Strong Association ◽  
Case Control ◽  
Stevens Johnson Syndrome ◽  
Thai Population ◽  
Johnson Syndrome ◽  
Cutaneous Reactions ◽  
Systemic Symptoms ◽  
Maculopapular Exanthema ◽  
Control Study

The HLA-B∗15:02 allele has been reported to have a strong association with carbamazepine-induced Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) in Thai patients. The HLA-B alleles associated with carbamazepine-induced maculopapular exanthema (MPE) and the drug reaction with eosinophilia and systemic symptoms (DRESS) among the Thai population have never been reported. The aim of the present study was to carry out an analysis of the involvement of HLA-B alleles in carbamazepine-induced cutaneous adverse drug reactions (cADRs) in the Thai population. A case-control study was performed by genotyping the HLA-B alleles of Thai carbamazepine-induced hypersensitivity reaction patients (17 MPE, 16 SJS/TEN, and 5 DRESS) and 271 carbamazepine-tolerant controls. We also recruited 470 healthy Thai candidate subjects who had not taken carbamazepine. HLA-B∗15:02 showed a significant association with carbamazepine-induced MPE (P=0.0022, odds ratio (OR) (95% confidence interval [CI]) = 7.27 (2.04–25.97)) and carbamazepine-induced SJS/TEN (P=4.46×10−13; OR (95% CI) = 70.91(19.67–255.65)) when compared with carbamazepine-tolerant controls. Carbamazepine-induced SJS/TEN also showed an association with HLA-B∗15:21 allele (P=0.013; OR (95% CI) = 9.54 (1.61–56.57)) when compared with carbamazepine-tolerant controls. HLA-B∗58:01 allele was significantly related to carbamazepine-induced MPE (P=0.007; OR (95% CI) = 4.73 (1.53–14.66)) and DRESS (P=0.0315; OR (95% CI) = 7.55 (1.20–47.58)) when compared with carbamazepine-tolerant controls. These alleles may serve as markers to predict carbamazepine-induced cADRs in the Thai population.

scholarly journals Amoxicillin induced erythematous maculopapular rashes: a case report

2020 ◽  
Vol 9 (5) ◽  
pp. 806
Author(s):  
Dhakchinamoorthi Krishna Kumar ◽  
Ravichandran Rajganesh ◽  
Dilli Batcha Jaya Shree ◽  
Sam Nikhil Cherian ◽  
Thayub Mohamed
Keyword(s):  
Adverse Drug Reaction Reporting ◽  
Stevens Johnson Syndrome ◽  
Beta Lactam ◽  
Drug Induced ◽  
Drug Eruptions ◽  
Immune Mediated ◽  
Johnson Syndrome ◽  
Lactam Antibiotic ◽  
Cutaneous Reactions ◽  
Maculopapular Rashes

Cutaneous adverse reactions (CAR) can occur with any class of drugs, however more widely caused by various antibiotics. Amoxicillin is a broad-spectrum, bactericidal, beta-lactam antibiotic, widely used for combating various infections. Cutaneous drug eruptions are known to be reported common while using penicillin class of drugs, specifically among children. These immune-mediated bizarre drug eruptions were range from mild to severe drug-induced cutaneous reactions, such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). The present case reported with maculopapular, erythematous rashes induced by amoxicillin in a nine-year-old male patient. Amoxicillin was prescribed for his hyperactive respiratory disease and subsequently after three days developed generalized maculopapular erythematous rashes as a result of an antibiotic-induced skin rash. The present case is being reported to add more data, also to emphasize and gather the information for evidence-based practice and to promote efficient pharmacovigilance adverse drug reaction reporting.

Stevens–Johnson syndrome and toxic epidermal necrolysis: a 10-year experience in a burns unit

2021 ◽  
Vol 30 (6) ◽  
pp. 492-496
Author(s):  
Khosrow S Houschyar ◽  
Christian Tapking ◽  
Mimi R Borrelli ◽  
Ina Nietzschmann ◽  
Behrus Puladi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Toxic Epidermal Necrolysis ◽  
Retrospective Review ◽  
Mortality Rates ◽  
Intravenous Immunoglobulins ◽  
Stevens Johnson Syndrome ◽  
Control Group ◽  
High Dose ◽  
Johnson Syndrome ◽  
Patient Reported

Objective: Stevens-Johnson syndrome (SJS) and its more severe counterpart, toxic epidermal necrolysis (TEN), are skin hypersensitivity reactions defined by epidermal blistering and necrosis. The exact pathophysiology of SJS/TEN is yet to be deciphered, but a number of risk factors have been identified including adverse drug reactions. The diagnosis of SJS/TEN is made on a clinical basis, and treatment consists of supportive care and occasionally immunosuppressants, such as cyclosporin, high-dose intravenous immunoglobulins and/or corticosteroids. Mortality rates can reach 20–25% in adults but are reduced with early intervention. To identify optimal treatment regimens, to better understand the patient cohort affected, and to help identify key risk factors for mortality, we report our experience with the treatment and management of SJS/TEN patients. Methods: A retrospective review of consecutive patients with SJS and/or TEN admitted to a single burns centre in Germany, between 2008 and 2018, was conducted. The primary outcomes of demographics, clinical course, treatment and patient-reported outcomes were recorded and compared with a control group of patients with burns without a diagnosis of SJS/TEN. Results: A total of 23 patients with SJS/TEN met the inclusion criteria: 17 (74%) with TEN; four (17%) with SJS/TEN overlap; and two (9%) with SJS. Of the patients, 14 (61%) were female and nine (39%) were male. Patient age ranged from 32–78 years (mean: 52 years). A matched cohort of 23 patients with burns served as the control group. All patients received standard of care with a multidisciplinary team. Compared with the control group, SJS/TEN patients had higher mortality rates (n=6, 26% versus n=8, 35%, respectively). The average age of death was 69 years in SJS/TEN patients versus 63 years in control group patients. Age and SCORTEN scores were significant predictors of mortality. Conclusions: SJS and TEN are rare but extreme reactions of the skin and mucosa, associated with high disease mortality rates. This 10-year single-centre retrospective review contributes to the bank of information for reviews evaluating the management of SJS/TEN patients.

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