scholarly journals A case of nimesulide induced toxic epidermal necrolysis

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.

scholarly journals Toxic epidermal necrolysis

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 951 ◽  
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.

scholarly journals Nimesulide induced toxic epidermal necrolysis: a rare case report

2017 ◽  
Vol 6 (12) ◽  
pp. 2939
Author(s):  
Vineet Kumar ◽  
Manju Gari ◽  
Kishor Chakraborty ◽  
Ravi Ranjan ◽  
Anshuman Chandra ◽  
...  
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Adverse Drug Reactions ◽  
Drug Reactions ◽  
Over The Counter ◽  
Medical Practitioners ◽  
Rare Case Report ◽  
Prescribed Medicines ◽  
Anti Fungal ◽  
Possible Cause ◽  
Antipyretic Action

Adverse drug reactions to the prescribed medicines are the major obstacles in continuation of drug treatment. Nimesulide, a selective cyclo-oxygenase (COX-2) inhibitor was first launched in Italy in 1985 and subsequently marketed in more than 50 countries including India. Due to its better and faster antipyretic action, it has gained popularity among physicians and paediatricians. Here, we report a case of 60 years old male patient who developed toxic epidermal necrolysis (TEN) following ingestion of tablet nimesulide. The patient was managed with parenteral corticosteroids, antibiotics, emollients, anti-fungal and supportive care. This case highlights the importance of nimesulide and other NSAIDs as possible cause of TEN. Nimesulide has never been approved in countries like USA, Canada, Britain, New Zealand, Australia. But in India it is available as over the counter drug and is used for various indications like fever, myalgia, arthralgia. Therefore, the drugs which are banned outside India should be used with caution and medical practitioners should report all the adverse drug reactions to such drugs. 

scholarly journals Serum Granulysin in Differentiation of Stevens-Johnson Syndrome/toxic Epidermal Necrolysis and Erythema Multiforme

2020 ◽  
Vol 8 (B) ◽  
pp. 381-388
Author(s):  
Tran Thi Huyen ◽  
Pham Dinh Hoa ◽  
Trinh Minh Trang ◽  
Riichiro Abe ◽  
Nguyen Van Thuong ◽  
...  
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Body Surface ◽  
Erythema Multiforme ◽  
The Body ◽  
Stevens Johnson Syndrome ◽  
Enzyme Linked Immunosorbent Assay ◽  
Drug Reactions ◽  
Skin Manifestation ◽  
Johnson Syndrome ◽  
Life Threatening

BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute, life-threatening drug reactions, which lead to massive epidermal necrolysis. Granulysin plays an important role as a key mediator for keratinocyte apoptosis in these conditions. Erythema multiforme (EM) may have skin manifestation similar to SJS/TEN. AIMS: The aim of the study was to compare serum granulysin levels in patients with SJS/TEN and EM as well as to investigate a possible association between serum granulysin levels and the severity of SJS/TEN. METHODS: In total, 48 patients with SJS/TEN, 43 patients with EM, and 20 health controls (HCs) were enrolled. We measured serum granulysin levels using enzyme-linked immunosorbent assay. RESULTS: The average level of serum granulysin in the SJS/TEN patients was 23.0 ng/ml (range 1.2–144.6 ng/ml), significantly higher than that of EM group (20.1 ng/ml; range 8.5–121 ng/ml, p < 0.05) and HCs group (20.8 ng/ml; range 10.1–46.7 ng/ml, p < 0.05). Of 48 SJS/TEN patients, the 25 samples collected <6 days after onset showed higher level of serum granulysin (27.7 ng/ml; range 2.5–144.6 ng/ml) than those collected ≥6 days after onset (17.9 ng/ml; range 1.2–59 ng/ml; p > 0.05). No significant correlation was found between serum granulysin levels and the body surface area affected and the modified-SCORTEN. At the day of re-epithelialization, serum granulysin levels were not different compared with those at the day of hospitalization. CONCLUSIONS: Serum granulysin levels are significantly higher in SJS/TEN group than in EM group. After the onset, serum granulysin levels in patients with SJS/TEN are not a good biomarker to evaluate the severity of the diseases.

scholarly journals Clinical Case of Toxic Epidermal Necrolysis

2017 ◽  
Vol 44 (1) ◽  
pp. 42-45 ◽  
Author(s):  
J. Radenkova-Saeva ◽  
H. Naydenov
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Antiretroviral Drugs ◽  
The Body ◽  
University Hospital ◽  
H2 Blockers ◽  
Oral Ulcers ◽  
Systemic Corticosteroids ◽  
The Face ◽  
Life Threatening ◽  
Loss Of Appetite

Abstract Toxic epidermal necrolysis or Lyell’s syndrome is a severe life-threatening adverse drug reaction with a high mortality rate. The drugs most commonly involved are: antibiotics; anticonvulsants; antiretroviral drugs; nonsteroidal anti-inflammatory drugs, allopurinol. Case report: A 68-year-old female, presented with complaints of fever and extensive rashes on the skin of the face, the neck and the trunk, severe itching of the skin, ulcerations and erythema of the conjunctiva and the oral cavity and difficulty in swallowing. She has a period of two or three days of general discomfort and fatigue, rash, fever up to 38°C, sore throat, arthralgia, myalgia, loss of appetite and have been treated with antipyretics, antibiotic – ampicillin, antihistamines, vitamins. Her state worsened during the next 3 days, therefore she was hospitalized in the Toxicology clinic of University Hospital “N. I. Pirogov”. Multiple maculopapular and bullous eruptions, plaques were present all over the body, blisters that cover a substantial portion of the body. The entire skin covering the body surface was denuded and peeled off with minor manipulation – the Nikolsky’s sign. Intraorally, multiple oral ulcers of the buccal mucosa, tongue, palate, labial mucosa, and soft palate were seen. Hemorrhagic erosions were also seen on both the upper and lower lips. Conjunctivitis and ulceration of genitalia were also noted. The lesions got slowly better with serum therapy, fluid and electrolyte replacement, systemic corticosteroids, antihistamines, antibiotic, vitamins, H2 blockers, topical care of mucosal changes. Evolution was satisfactory with epidermization and the patient was discharged from the hospital after 1 month.

Phenolphthalein-Induced Toxic Epidermal Necrolysis

1997 ◽  
Vol 31 (10) ◽  
pp. 1157-1159 ◽  
Author(s):  
Richard J Artymowicz ◽  
Arthur L Childs ◽  
Lawrence Paolini
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Wound Care ◽  
Microscopic Analysis ◽  
Medication History ◽  
Drug Induced ◽  
Over The Counter ◽  
Urticarial Rash ◽  
Intravenous Antibiotics ◽  
Light Microscopic Analysis

OBJECTIVE: To report a case of phenolphthalein-induced toxic epidermal necrolysis (TEN) in a patient maintained on several other medications more commonly known to be associated with TEN. CASE SUMMARY: A 78-year-old white man presented with intractable lower back pain and constipation. On day 1 of admission, the patient exhibited a diffuse urticarial rash over his trunk and extremities. History revealed that the patient had taken a combination phenolphthalein/docusate sodium (Correctol) over-the-counter laxative 1 day prior to admission. He had a similar urticarial rash 1.5 years earlier with this product and was instructed not to use it. A biopsy was performed and evidence from light microscopic analysis of the tissue led to a diagnosis of TEN. Furosemide, spironolactone, allopurinol, and hydroxyurea were considered possible causes of the reaction and were discontinued. Despite this, the lesions worsened in severity. The patient subsequently responded well to intravenous antibiotics, intravenous corticosteroids, and local wound care. Furosemide, spironolactone, hydroxyurea, allopurinol, and docusate were all reintroduced without reactivation of the lesions. DISCUSSION: phenolphthalein is the active ingredient in several over-the-counter laxative preparations and has only rarely been reported to cause TEN. (It is no longer contained in Correctol.) To our knowledge, this case report represents only the third description of laxative-induced TEN. Although this patient had been exposed to several other medications more commonly associated with TEN, his long-term tolerance of and uneventful rechallenge with these medications exclude them as potential catalysts to this drug reaction. The patient's previous rash and the temporal relation of this event and the ingestion of phenolphthalein, as well as the similarity of this case to other reports, point to phenolphthalein as the cause of TEN in this patient. CONCLUSIONS: TEN is a rare disorder that can be fatal in up to 30% of patients. Clinicians should include phenolphthalein in their list of possible causes of drug-induced TEN. A careful and complete medication history can help avoid unnecessary discontinuation of clinically important medications and inadvertent rechallenge with the causative agent.

Contac 400: A Possible Cause of Aspiration Under Anaesthesia

1987 ◽  
Vol 6 (6) ◽  
pp. 529-531
Author(s):  
D.J. Wilkinson
Keyword(s):  
Over The Counter ◽  
Counter Medication ◽  
Life Threatening ◽  
Anaesthetic Assessment ◽  
Possible Cause

Patients often take proprietary medicines which they do not report to their anaesthetist. One such case is reported in which a self administered high dosage of such a medication can be linked with a potentially life threatening anaesthetic complication. Pre-anaesthetic assessment should include specific questioning on over-the-counter medication.

scholarly journals Toxic Epidermal Necrolysis (TEN)/Stevens-Johnson Syndrome (SJS) Epidemiology and Mortality Rate at King Fahad Specialist Hospital (KFSH) in Qassim Region of Saudi Arabia: A Retrospective Study

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Abdullah Alajaji ◽  
Jagannath Chandra Shekaran ◽  
Omar Mohammed Aldhabbah ◽  
Hajar Abdullah Alhindi ◽  
Nouf Salem Almazyad ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Mortality Rate ◽  
Toxic Epidermal Necrolysis ◽  
Chart Review ◽  
Small Sample Size ◽  
Retrospective Chart Review ◽  
Small Sample ◽  
Stevens Johnson Syndrome ◽  
Johnson Syndrome ◽  
Life Threatening

Background. Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are life-threatening conditions caused by drug reactions. There are multiple causative drugs and different risk factors associated with SJS/TEN. Objectives. To study the epidemiology of SJS/TEN and associated mortality rate in Qassim region, Saudi Arabia. Methodology. A retrospective chart review of all patients with the diagnosis of SJS/TEN who were admitted to King Fahad Specialist Hospital (KFSH) in Qassim region, Saudi Arabia, for the period between Jan 2014 to Jan 2019. The Careware information health system is used at KFSH, and patients were identified searching the diagnosis SJS/TEN. Results. Total of 10 patients with diagnosis of SJS/TEN were admitted to KFSH for the period from Jan 2014 to Jan 2019. Antibiotics were the culprit in 5 out of 10 patients. 9 out of 10 patients survived with good outcome. One patient with the diagnosis of TEN died, given extensive skin involvement complicated by sepsis. Conclusion. Despite the limitation of this study given small sample size, this is the first study of its kind that discusses the epidemiology of SJS/TEN in Saudi Arabia. We found the estimated incidence rate of SJS/TEN in Qassim region to be 7.6 cases per million person-years. Antibiotics and antiepileptics were the culprits in 8 out of 10 patients.

scholarly journals Toxic Epidermal Necrolysis and Graft-versus-Host Reaction: Revisiting a Puzzling Similarity

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
G. E. Piérard ◽  
T. Hermanns-Lê ◽  
P. Paquet ◽  
A. F. Rousseau ◽  
P. Delvenne ◽  
...  
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Inflammatory Cell ◽  
Skin Lesions ◽  
Graft Versus Host Reaction ◽  
Host Reaction ◽  
Drug Induced ◽  
Effector Cells ◽  
Graft Versus Host ◽  
Life Threatening ◽  
Skin Biopsies

Drug-induced toxic epidermal necrolysis (TEN) and acute cutaneous graft-versus-host reaction (GVHR) under immunopreventive therapy share some histopathological resemblance. So far, there are no serum biomarkers and no immunohistochemical criteria distinguishing with confidence and specificity the skin lesions of TEN and GVHR. Both diseases present as an inflammatory cell-poor necrotic reaction of the epidermis. This report compares three sets of 15 immunostaining patterns found in TEN, GVHR, and partial thickness thermal burns (PTTB), respectively. Three series of 17 skin biopsies were scrutinized. Irrespective of the distinct causal pathobiology of TEN and GVHR, similar secondary effector cells were recruited in lesional skin. Burns were less enriched in cells of the monocyte-macrophage disease. These cells likely exert deleterious effects in TEN and GVHR and cannot be simply regarded as passive bystanders. These life-threatening conditions are probably nursed, at least in part, by macrophages.

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

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Abhijit Swami ◽  
Bhaskar Gupta ◽  
Prithwiraj Bhattacharjee
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Toxic Epidermal Necrolysis ◽  
Case Reports ◽  
First Line ◽  
Drug Induced ◽  
Antitubercular Drugs ◽  
Disseminated Tuberculosis ◽  
Mucous Membranes ◽  
Life Threatening

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.

scholarly journals Bronchiolitis obliterans following toxic epidermal necrolysis: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Ujjwal Prakash Khanal ◽  
Akash Roy ◽  
Arun Kumar Sharma
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Bronchiolitis Obliterans ◽  
Clinical Course ◽  
Supportive Therapy ◽  
Skin Condition ◽  
Pulmonary Complications ◽  
Drug Induced ◽  
Case Presentation ◽  
Ocular Manifestations ◽  
Life Threatening

Abstract Background Toxic epidermal necrolysis (TEN) is a rare, acute and potentially fatal skin condition usually induced by drugs. Although much attention is focused on the life threatening acute cutaneous and sight threatening ocular manifestations of this disease, chronic pulmonary complications like bronchiolitis obliterans are occasionally encountered. However, little is known about its incidence, pathogenesis, clinical course and outcome in children recovering from TEN. Case presentation We report a five-year-old boy who presented four months after the first manifestation of drug-induced TEN with cough and shortness of breath and was subsequently diagnosed with bronchiolitis obliterans. He was treated with supportive therapy that improved his hypercapnia allowing him to be discharged on domiciliary oxygen, chest physiotherapy and bronchodilators. Conclusions This case highlights the need to be vigilant for adverse drug reactions and consider chronic pulmonary complications like Bronchiolitis Obliterans in children recovering from TEN.

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