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 rare case of oxcarbazepine induced Stevens Johnson Syndrome: toxic epidermal necrosis overlap

2017 ◽  
Vol 6 (2) ◽  
pp. 466
Author(s):  
Aditi Maitra ◽  
Shashwat Bhattacharyya ◽  
Shatavisa Mukherjee ◽  
Nikhil Era
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Adverse Drug Reactions ◽  
Rare Case ◽  
Stevens Johnson Syndrome ◽  
Toxicity Profile ◽  
Drug Reactions ◽  
Clinical Safety ◽  
Drug Eruptions ◽  
Johnson Syndrome ◽  
Epidermal Necrosis

Oxcarbazepine is a closely related analogue of carbamazepine and is useful in the monotherapy of seizures with an improved toxicity profile. Its clinical safety has been recently put under scrutiny as evidence has emerged about its adverse drug reactions and it is increasingly being reported to cause cutaneous drug eruptions. Here we report a rare case of oxcarbazepine induced Stevens Johnson - toxic epidermal necrolysis overlap.

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.

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.

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 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.

Phenytoin Induced Stevens Johnson Syndrome- Toxic Epidermal Necrolysis Overlap Exacerbated by Cephalexin in a 65-Year-Old Neurosurgical Patient: A Rare Case Report

2021 ◽  
Vol 13 ◽  
Author(s):  
Kiran Kumar Rathinam ◽  
Sarvesh Sabarathinam ◽  
Poojith Nuthalapati ◽  
Vijayakumar Thangavel Mahalingam
Keyword(s):  
Case Report ◽  
Rare Case ◽  
Detailed Examination ◽  
The Body ◽  
Stevens Johnson Syndrome ◽  
Communicating Hydrocephalus ◽  
Drug Induced ◽  
Johnson Syndrome ◽  
Rare Case Report ◽  
Epidermal Necrosis

Objective: To report a rare case of drug induced overlap of Stevens-Johnson syndrome and Toxic Epidermal Necrosis Syndrome exacerbated by cephalexin. Case summary: In this case report we present a 65-year-old female who had come to the hospital with complaints of Sloughing of the skin and redness all over the body with raised body temperature. She was on therapeutic Phenytoin to prevent the post-surgical complications of Communicating Hydrocephalus. After a detailed examination it was found that the patient had misemployed with an overdose of Phenytoin. The patient was found with nikolsky sign and diagnosed as Stevens-Johnson syndrome and Toxic Epidermal Necrosis overlap. This case report emphasizes phenytoin induced Stevens-Johnson syndrome and Toxic Epidermal Necrosis syndrome exacerbated by cephalexin. Practice implications: By witnessing this phenomenon, we could figure out the association between cephalexin and Stevens-Johnson syndrome- Toxic Epidermal Necrosis syndrome overlap. The Immediate dismissal of the offending agent and commencement of supportive care was found to be effective.

scholarly journals Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Review of Diagnosis and Management

Medicina ◽  
2021 ◽  
Vol 57 (9) ◽  
pp. 895
Author(s):  
Robert Frantz ◽  
Simo Huang ◽  
Abhirup Are ◽  
Kiran Motaparthi
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Stevens Johnson Syndrome ◽  
Controlled Trials ◽  
Significant Morbidity ◽  
Diagnosis And Management ◽  
Randomized Controlled ◽  
Johnson Syndrome ◽  
Early Phases ◽  
Epidermal Necrosis ◽  
Potential Biomarkers

Stevens–Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare diseases that are characterized by widespread epidermal necrosis and sloughing of skin. They are associated with significant morbidity and mortality, and early diagnosis and treatment is critical in achieving favorable outcomes for patients. In this scoping review, Excerpta Medica dataBASE and PubMed were searched for publications that addressed recent advances in the diagnosis and management of the disease. Multiple proteins (galectin 7 and RIP3) were identified that are promising potential biomarkers for SJS/TEN, although both are still in early phases of research. Regarding treatment, cyclosporine is the most effective therapy for the treatment of SJS, and a combination of intravenous immunoglobulin (IVIg) and corticosteroids is most effective for SJS/TEN overlap and TEN. Due to the rare nature of the disease, there is a lack of prospective, randomized controlled trials and conducting these in the future would provide valuable insights into the management of this disease.

Unnecessary Biopsy?

PEDIATRICS ◽  
1981 ◽  
Vol 67 (3) ◽  
pp. 444-444
Author(s):  
Benjamin C. Berliner
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Mucous Membrane ◽  
Erythema Multiforme ◽  
Scarlet Fever ◽  
Stevens Johnson Syndrome ◽  
Staphylococcal Scalded Skin Syndrome ◽  
Johnson Syndrome ◽  
Mucous Membranes ◽  
Clinical Description ◽  
Typical Instance

The clinical description of the little girl's disease which is provided in the article by Manzella et al1 is certainly sufficient for a diagnosis, and biopsy rather than being "essential" is an unnecessary and unwarranted intervention. I am puzzled by the diagnostic term "toxic epidermal necrolysis" as used here. What is described is a typical instance of erythema multiforme bullosa (Stevens-Johnson syndrome), a disorder which involves the mucous membranes as well as the skin. This entity is readily distinguishable from the staphylococcal scalded skin syndrome (toxic epidermal necrolysis, staphylococcal scarlet fever, Ritter's disease of the newborn) by the fact that the latter patients exhibit neither bullae nor mucous membrane involvement.

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