scholarly journals Toxic Epidermal Necrolysis/Stevens-Johnson Syndrome at A University Hospital in Saudi: Causative Factors and Outcomes

2022 ◽  
Author(s):  
Amal A Kokandi
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Small Sample Size ◽  
Intravenous Immunoglobulins ◽  
Small Sample ◽  
University Hospital ◽  
Stevens Johnson Syndrome ◽  
Johnson Syndrome ◽  
Causative Agents ◽  
Life Threatening ◽  
King Abdulaziz University

Abstract Introduction:Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are rare, life-threatening conditions caused mainly by drugs. Their management relies on the withdrawal of the culprit medication and supportive measures. Different pharmacotherapies have varied effects. However, data related to TEN and SJS in Saudi is limited. This study aimed to identify the causative agents, associated factors, and outcomes of TEN/SJS cases admitted to a teaching hospital (King Abdulaziz University) in Jeddah during the last 10 years.Methods: We retrospectively analyzed the data of TEN/SJS patients admitted to the hospital over the last 10 years.Results: We identified 12 patients with TEN/SJS. Of these, nine survived the condition and were discharged. The culprit medication was identified in eight of them, including antibiotics in six cases and Tegretol and allopurinol in one case each. Most of the patients received systemic steroids and intravenous immunoglobulins.Conclusion: TEN/SJS is mainly caused by medications of which antibiotics are the most implicated. Consistent with other studies, the mortality rate associated with TEN/SJS in Saudi is 25%. Limitations: restricted to a single center and small sample size.

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 Fatal case of toxic epidermal necrolysis induced by ciproflfl oxacin in a child

2021 ◽  
Vol 12 (Supp 1) ◽  
pp. 26-29
Author(s):  
Thomas Schiestel
Keyword(s):  
Case Report ◽  
Toxic Epidermal Necrolysis ◽  
Adverse Reactions ◽  
Pediatric Population ◽  
Fatal Case ◽  
Stevens Johnson Syndrome ◽  
Delayed Treatment ◽  
Drug Eruptions ◽  
Johnson Syndrome ◽  
Life Threatening

Bullous drug eruptions such as Toxic Epidermal Necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are rare but known adverse reactions of fluoroquinolones. Although uncommon, TEN can be life-threatening for the patient, especially in the context of delayed treatment and in fragile patients such as the pediatric population. In the present case, TEN occurred in a 13-year-old girl with no medical history following initiation of ciprofloxacin treatment for an inguinal cyst. We hope that the case report will make interrogate the practices concerning the use of antibiotics, in particular fluoroquinolones in the context of an use not prescribed by the Marketing Authorization of the drug in children.

scholarly journals Meropenem-induced Stevens-Johnson syndrome/toxic epidermal necrolysis in a patient with known type IV penicillin hypersensitivity

2019 ◽  
Vol 12 (8) ◽  
pp. e230144 ◽  
Author(s):  
Muhammad Sameed ◽  
Christine Nwaiser ◽  
Prashant Bhandari ◽  
Sarah A Schmalzle
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Cross Reactivity ◽  
Delayed Hypersensitivity ◽  
Stevens Johnson Syndrome ◽  
Hypersensitivity Reactions ◽  
Beta Lactam ◽  
Type Iv ◽  
Johnson Syndrome ◽  
Life Threatening ◽  
History Of

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are considered variants of a disease continuum that results in a life-threatening exfoliative mucocutaneous disease. These are categorised as type IV cell-mediated delayed hypersensitivity reactions, and antibiotics are often implicated as a cause. Penicillins and other beta-lactam antibiotics are known to cause both immediate and delayed hypersensitivity reactions. While immediate IgE-mediated cross-reactivity between penicillins and carbapenems is well studied, less information on the risk of type IV delayed cell-mediated cross-reactivity between the two is available. We present a case of meropenem-induced SJS in a patient with documented history of SJS from amoxicillin. There are few cases of cross-reactivity with carbapenems reported in the literature, but based on the potential for life-threatening reaction, it is likely prudent to avoid the use of any beta-lactams in a patient with a history of SJS, TEN or any other severe cutaneous adverse reactions to another beta-lactam antibiotic.

scholarly journals HIV-Associated Toxic Epidermal Necrolysis at San Francisco General Hospital

2016 ◽  
Vol 16 (1) ◽  
pp. 37-41 ◽  
Author(s):  
Jossy Tseng ◽  
Toby Maurer ◽  
Misha M. Mutizwa
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Retrospective Analysis ◽  
General Hospital ◽  
San Francisco ◽  
Antimicrobial Agents ◽  
Small Sample Size ◽  
Small Sample ◽  
Hiv Positive ◽  
Drug Reactions ◽  
Causative Agents

Objectives: We sought to characterize recent cases of toxic epidermal necrolysis (TEN) in HIV-infected patients at San Francisco General Hospital (SFGH), a large HIV referral center. Methods: This was a retrospective analysis of HIV-infected patients diagnosed with TEN from January 2001 to May 2014 at SFGH. Results: Ten cases of TEN were identified, 50% of which occurred in HIV-infected individuals. Among the HIV-associated cases, causative agents were trimethoprim–sulfamethoxazole (TMP-SMX; n = 2), atovaquone, clindamycin, and fluconazole. No antiretroviral agents were implicated. Conclusion: Although limited by small sample size, our experience is reflective of the well-recognized increased incidence of TEN in HIV-positive patients and suggests that antimicrobial agents, particularly TMP-SMX, are the most common causative agents in this population. As 3 of the 5 HIV-associated TEN cases were caused by potentially inappropriate or unnecessary use of antibiotics, our experience highlights the importance of judicious use of systemic medications in populations susceptible to severe adverse drug reactions.

scholarly journals DRUG-INDUCED STEVENS-JOHNSON SYNDROME AND TOXIC EPIDERMAL NECROLYSIS

2016 ◽  
Vol 65 (4) ◽  
pp. 377-381
Author(s):  
Dalia Dop ◽  
◽  
Desdemona Stepan ◽  
Cristian Gheonea ◽  
Elena Carmen Niculescu ◽  
...  
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Rare Diseases ◽  
Intravenous Immunoglobulins ◽  
Stevens Johnson Syndrome ◽  
Drug Induced ◽  
Johnson Syndrome ◽  
Medical Emergencies ◽  
Steven Johnson Syndrome ◽  
Restitutio Ad Integrum

Steven-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare diseases that appear following the administration of risk drugs. Both are severity grades of the same condition and are considered medical emergencies, because they are potentially lethal. They are characterized by mucocutaneous tenderness, erythema, necrosis and bullous detachment similar to extended burns. We report 3 cases of SJS/TEN in which the etiology was probably drug-related (Paracetamol, Atomoxetinum, Sulfamethoxazolum + trimethoprinum), with restitutio ad integrum following the administration of intravenous immunoglobulins.

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.

Pharmacogenomics of lamotrigine: a possible link to serious cutaneous adverse reactions

2015 ◽  
Vol 5 (2) ◽  
pp. 78-81
Author(s):  
Rebecca Campbell ◽  
Jennifer Beall
Keyword(s):  
Genetic Polymorphisms ◽  
Smoking Status ◽  
Small Sample Size ◽  
Boxed Warning ◽  
Small Sample ◽  
Stevens Johnson Syndrome ◽  
Case Control Studies ◽  
Skin Reactions ◽  
Johnson Syndrome ◽  
Concomitant Medications

Abstract Introduction Lamotrigine's packaging contains a boxed warning for serious skin reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis. The purpose of this review is to summarize literature pertaining to HLA genetic polymorphisms that may increase susceptibility to serious skin reactions induced by lamotrigine. Methods A literature search of PubMed/MEDLINE and Ovid IPA was conducted using the following search terms: lamotrigine, genetic polymorphism, pharmacogenetics, pharmacogenomics, predictive genetic testing, anticonvulsants, hypersensitivity, and HLA-B. Results Three case-control studies were identified focusing on genetic polymorphisms that can cause direct susceptibility to serious skin reactions, such as HLA-B*1502. Other factors were also taken into consideration, such as age, concomitant medications, ethnicity, and smoking status. Most results were not statistically significant but rather hypothesis generating and were limited by small sample size and study design. Discussion Further studies are needed to better determine a relationship between genetic polymorphisms and lamotrigine-induced serious skin reactions. However, clinicians should exercise caution when prescribing lamotrigine to patients in whom relevant genetic polymorphisms, such as HLA-B*1502, may be present, such as those of Southeast Asian descent.

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