scholarly journals Hydroxychloroquine-Induced Stevens-Johnson Syndrome in COVID-19: A rare Case Report

2020 ◽  
Author(s):  
Lotfollah Davoodi ◽  
Hamed Jafarpour ◽  
Armaghan Kazeminejad ◽  
Eissa Soleymani ◽  
Zahra Akbari ◽  
...  
Keyword(s):  
Side Effects ◽  
Ground Glass Opacity ◽  
Respiratory Illness ◽  
Upper Extremities ◽  
Definitive Treatment ◽  
Stevens Johnson Syndrome ◽  
Nasopharyngeal Swab ◽  
Entire Body ◽  
Her Family ◽  
Johnson Syndrome

Abstract Background: The international outbreak of respiratory illness termed coronavirus disease 2019 (COVID-19) began in December 2019 that has affected more than 0.8 million individuals. To date, there are no specific therapeutic agents for coronavirus infections. One of the drugs that have an effective role in improving the condition of patients with COVID-19 is hydroxychloroquine (HCQ). This drug is not a definitive treatment for this disease and has a supportive role. Like all medications, HCQ has side effects and may occur in COVID-19 patients. Stevens-Johnson syndrome caused by HCQ is very rare.Case presentation: A 42-year-old woman, presented with fever and dry cough in the past two days to her family physician. Lab tests revealed elevated lactate dehydrogenase (LDH, 648 units/liter (U/L)), C-reactive protein level (CRP, 52 milligrams/Liter (mg/L), normal: <10 mg/L), aspartate aminotransferase (AST, 59 U/L, normal: 10-40 U/L), thrombocytopenia, and leukopenia. Mild bilateral patchy ground-glass opacity was seen in lung CT-Scan. Due to COVID-19 pandemic and clinical findings, the nasopharyngeal swab test was done and SARS-CoV-2 nucleic acid was detected by RT-PCR. HCQ 200 mg twice daily was started. After two days, the patient presented with a pruritic erythematous maculopapular rash and flat atypical targets that started from the distal of upper extremities and rapidly, involved the entire body, and torn blisters which were only be seen as ulcers on orolabial area. The Nikolsky sign was positive. Due to the likelihood of a drug reaction, HCQ was discontinued, and COVID-19 treatment was changed to lopinavir/ritonavir (LPV/RTV) 400 mg twice daily. Finally, she was discharged after five days with nonpruritic scalded skin on the distal of upper extremities. Conclusions: It is worth noting that although HCQ appears to be safe and has mild side effects, however, the boundary between therapeutic and toxic doses is narrow and severe disorders of their use can life-threatening. One of the side effects of HCQ is SJS caused by the drug, and given the worldwide pandemic of COVID-19 and the increasing need for this drug, we need to be careful about its use in order to control and manage the side effects of this drug.

scholarly journals Hydroxychloroquine-induced Stevens–Johnson syndrome in COVID-19: a rare case report

2020 ◽  
Vol 2020 (6) ◽  
Author(s):  
Lotfollah Davoodi ◽  
Hamed Jafarpour ◽  
Armaghan Kazeminejad ◽  
Eissa Soleymani ◽  
Zahra Akbari ◽  
...  
Keyword(s):  
Multiorgan Failure ◽  
Severe Pneumonia ◽  
Respiratory Illness ◽  
Maculopapular Rash ◽  
Stevens Johnson Syndrome ◽  
Entire Body ◽  
Inflammatory Reactions ◽  
Johnson Syndrome ◽  
Rare Case Report ◽  
Tract Involvement

Abstract The international outbreak of respiratory illness termed coronavirus disease 2019 (COVID-19) began in December 2019 that has affected &gt;0.8 million individuals. Self-limiting respiratory tract involvement, severe pneumonia, multiorgan failure and death are the spectrum of COVID-19. To date, there are no especial therapeutic agents for COVID-19 infections. One such medication includes the antimalarial hydroxychloroquine (HCQ), which recently reported as a possible therapy for shortening the duration of COVID-19 symptoms, reducing inflammatory reactions to infection, impairing the exacerbation of pneumonia and boosting lung imaging findings. Like all medications, HCQ has side effects and may occur in COVID-19 patients. Here, we report on the case of a 42-year-old woman, presented with fever and dry cough, who had COVID-19 and 2 days later presented with a pruritic erythematous maculopapular rash, which started from the distal of upper extremities and rapidly, involved the entire body.

A Review on Analytical Method for Determination of Lamotrigine in Bulk and Pharmaceutical Dosage Form

2021 ◽  
pp. 229-234
Author(s):  
Rutuja S Nalkar ◽  
Suhas S Siddheshwar ◽  
Mahesh H Kolhe
Keyword(s):  
Side Effects ◽  
Blood Cells ◽  
Anticonvulsant Drug ◽  
Mood Stabilizer ◽  
Stevens Johnson Syndrome ◽  
Partial Seizures ◽  
Pharmaceutical Dosage Form ◽  
Johnson Syndrome ◽  
Clonic Seizures

Lamotrigine is an anticonvulsant drug used in the treatment of epilepsy & bipolar disorder/major affective disorder (manic depression). Lamotrigine is and antiepileptic drug of phenyltriazine class. For epilepsy it is used to treat the partial seizures, primary and secondary tonic-clonic seizures, and seizures associated with the Lennox-Gastuat syndrome and are chemically unrelated to the other anticonvulsants. Lamotrigine is a phenyltriazine that has comparatively few side-effects and it does not requires blood monitoring/observance in monotherapy. It additionally acts as a mood stabilizer. Common side-effects of lamotrigine include, nausea, sleepiness, headache, vomiting, trouble/bother with co-ordination and rash. Serious side-effects include in, lack of red blood cells, accumulated in risk of suicide, Stevens-Johnson syndrome and allergy. It issues that use of lamotrigine throughout pregnancy or breastfeeding it’s going to lead/result in harm/damage.

scholarly journals DRUG INDUCED DERMATOLOGICAL REACTION OF THE 100 MOST COMMONLY PRESCRIBED MEDICATIONS IN UK HOSPITALS

2019 ◽  
pp. 54-57
Author(s):  
MOHAMMED AL-ABADIE ◽  
FARIS OUMEISH ◽  
MOHAMMED AL-RUBAYE ◽  
DINA AL-ABADIE ◽  
PATRICK ANTHONY BALL ◽  
...  
Keyword(s):  
United Kingdom ◽  
Side Effects ◽  
Stevens Johnson Syndrome ◽  
Drug Induced ◽  
The United Kingdom ◽  
Johnson Syndrome ◽  
Medication Side ◽  
Drug Adverse Reaction ◽  
Skin Conditions ◽  
Dermatological Side Effects

Objective: It is commonly reported that medicines have side effects related to dermatological practice. However, it is extremely difficult to establish how commonly, or rarely skin-related medication side effects occur. Common dermatological side effects include rash, pruritus, and photosensitivity. Objective: To demonstrate the dermatological side-effects of the most commonly prescribed medications in the United Kingdom. Methods: This paper discusses dermatological side-effects of the commonly prescribed medications, including uncommon or rare manifestations such as angioedema and Stevens - Johnson syndrome (SJS). The list used for the most frequently prescribed drugs in the United Kingdom was created by nurses. This list was compared to the British National Formulary to demonstrate the reported frequency of occurrence of dermatological side-effects or complications. Conclusion: The top 100 prescribed medication cause a number of dermatological side effects that need to be considered when they are prescribed to patients who have pre-existing skin conditions. Additionally, when confronted with a common dermatological problem in any patient, clinicians should always consider the possibility of a drug adverse reaction.

Differences in Treatment of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis at Burn Centers and Nonburn Centers

2020 ◽  
Vol 41 (5) ◽  
pp. 945-950
Author(s):  
Rachel M Nygaard ◽  
Frederick W Endorf
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Severe Disease ◽  
Definitive Treatment ◽  
Stevens Johnson Syndrome ◽  
Skin Disorders ◽  
National Inpatient Sample ◽  
Term Care ◽  
Burn Centers ◽  
Burn Center ◽  
Johnson Syndrome

Abstract Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and Stevens–Johnson/TEN overlap syndrome (SJS/TEN) are severe exfoliative skin disorders resulting primarily from allergic drug reactions and sometimes from viral causes. Because of the significant epidermal loss in many of these patients, many of them end up receiving treatment at a burn center for expertise in the care of large wounds. Previous work on the treatment of this disease focused only on the differences in care of the same patients treated at nonburn centers and then transferred to burn centers. We wanted to explore whether patients had any differences in care or outcomes when they received definitive treatment at burn centers and nonburn centers. We queried the National Inpatient Sample database from 2016 for patients with SJS, SJS/TEN, and TEN diagnoses. We considered burn centers as those with greater than 10 burn transfers to their center and fewer than 5 burn transfers out of their center in a year. Multivariable logistic regression assessed factors associated with treatment at a burn center and mortality. Using the National Inpatient Sample, a total of 1164 patients were identified. These were divided into two groups, nonburn centers vs burn centers, and those groups were compared for demographic characteristics as well as variables in their hospital course and outcome. Patients treated at nonburn centers were more likely to have SJS and patients treated at burn centers were more likely to have both SJS/TEN and TEN. Demographics were similar between treatment locations, though African-Americans were more likely to be treated at a burn center. Burn centers had higher rates of patients with extreme severity and mortality risks and a longer length of stay. However, burn centers had similar actual mortality compared to nonburn centers. Patients treated at burn centers had higher charges and were more likely to be transferred to long-term care after their hospital stay. The majority of patients with exfoliative skin disorders are still treated at nonburn centers. Patients with SJS/TEN and TEN were more likely to be treated at a burn center. Patients treated at burn centers appear to have more severe disease but similar mortality to those treated at nonburn centers. Further study is needed to determine whether patients with these disorders do indeed benefit from transfer to a burn center.

Stevens-Johnson syndrome manifesting late in the course of pembrolizumab therapy

2018 ◽  
Vol 25 (6) ◽  
pp. 1520-1522 ◽  
Author(s):  
Andrew Hwang ◽  
Andrew Iskandar ◽  
Constantin A Dasanu
Keyword(s):  
Cell Death ◽  
Side Effects ◽  
Programmed Cell Death ◽  
Toxic Epidermal Necrolysis ◽  
Death Receptor ◽  
Favorable Outcome ◽  
Stevens Johnson Syndrome ◽  
Erythematous Rash ◽  
Johnson Syndrome ◽  
Cell Death Receptor

Pembrolizumab is a humanized antibody that targets programmed cell death receptor-1. This agent is approved for use in the treatment of several malignancies. While pruritus and papulo-erythematous rash are not uncommon with its use, severe reactions such as Stevens-Johnson syndrome/toxic epidermal necrolysis are very rare. We present herein a case of Stevens-Johnson syndrome occurring in a patient who had previously tolerated pembrolizumab without significant side effects for seven months. Prompt recognition of Stevens-Johnson syndrome/toxic epidermal necrolysis and discontinuation of the offending agent are paramount to ensure a favorable outcome.

scholarly journals Pulse therapy in pemphigus: report of 11 cases

2013 ◽  
Vol 88 (4) ◽  
pp. 672-675 ◽  
Author(s):  
Nurimar Conceicao Fernandes ◽  
Mariana Menezes
Keyword(s):  
Side Effects ◽  
Maintenance Dose ◽  
Pemphigus Vulgaris ◽  
Pulse Therapy ◽  
Stevens Johnson Syndrome ◽  
Pemphigus Foliaceus ◽  
Cyclophosphamide Pulse Therapy ◽  
Johnson Syndrome ◽  
Cyclophosphamide Pulse

In this study, five cases of pemphigus vulgaris and two cases of pemphigus foliaceus were treated with cyclophosphamide pulse therapy associated with prednisone, resulting in the need for a smaller maintenance dose of prednisone. In three cases of pemphigus vulgaris and one case of pemphigus foliaceus, dexamethasone and cyclophosphamide pulse therapy associated with prednisone helped the lesions to heal more rapidly. Neither treatment however prevented the recurrence of the disease. Amenorrhea, myelotoxicity and Stevens-Johnson syndrome were among the cyclophosphamide side effects. All the patients treated with prednisone experienced known side effects.

Second-Messenger Modifiers (“Mood Stabilizers”)

2018 ◽  
pp. 127-145
Author(s):  
S. Nassir Ghaemi
Keyword(s):  
Clinical Pharmacology ◽  
Side Effects ◽  
Renal Insufficiency ◽  
Gold Standard ◽  
Second Messenger ◽  
Mood Stabilizers ◽  
Stevens Johnson Syndrome ◽  
Dementia Prevention ◽  
Johnson Syndrome ◽  
Ovarian Syndrome

The drug class of second-messenger modifiers includes agents called “mood stabilizers.” It consists of lithium and some anticonvulsants: valproate, carbamazepine, and lamotrigine. The standard mood stabilizers each have strengths and weaknesses. Lithium is still the gold standard, most proven agent; no other drug has been clearly shown to be more effective than lithium. The clinical pharmacology of specific agents within each class, including their efficacy and side effects, is explored. Specific phenomena that are surveyed include chronic renal insufficiency, liver side effects, polycystic ovarian syndrome, teratogenicity, Stevens-Johnson syndrome, and drug interactions. Benefits for lithium include suicide prevention and possibly dementia prevention.

549 Differences in Treatment of Stevens-johnson Syndrome and Toxic Epidermal Necrolysis at Burn Centers and Non-burn Centers

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S114-S115
Author(s):  
Rachel Nygaard ◽  
Frederick W Endorf
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Severe Disease ◽  
Definitive Treatment ◽  
Stevens Johnson Syndrome ◽  
Skin Disorders ◽  
Term Care ◽  
Burn Centers ◽  
Burn Center ◽  
Johnson Syndrome

Abstract Introduction Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap syndrome (SJS/TEN) are severe exfoliative skin disorders resulting primarily from allergic drug reactions and sometimes from viral causes. Because of the significant epidermal loss in many of these patients, many of them end up receiving treatment at a burn center for expertise in the care of large wounds. Previous work on the treatment of this disease focused only on the differences in care of the same patients treated at non-burn centers and then transferred to burn centers. We wanted to explore whether patients had any differences in care or outcomes when they received definitive treatment at burn centers and non-burn centers. Methods We queried the National Inpatient Sample (NIS) database from 2016 for patients with SJS, SJS/TEN, and TEN diagnosis. We considered burn centers as those with greater than 10 burn transfers to their center and fewer than 5 burn transfers out of their center in a year. Multivariable logistic regression assessed factors associated with treatment at a burn center and mortality. Results Using the NIS, a total of 1164 patients were identified. These were divided into two groups, non-burn centers vs. burn centers, and those groups were compared for demographic characteristics as well as variables in their hospital course and outcome. Patients treated at non-burn centers were more likely to have SJS and patients treated at burn centers were more likely to have both SJS/TEN and TEN. Demographics were similar between treatment locations, though African-Americans were more likely to be treated at a burn center. Burn centers had higher rates of patients with extreme severity and mortality risks, and a longer length of stay. However, burn centers had similar actual mortality compared to non-burn centers. Patients treated at burn centers had higher charges and were more likely to be transferred to long-term care after their hospital stay. Conclusions The majority of patients with exfoliative skin disorders are still treated at non-burn centers. Patients with SJS/TEN and TEN were more likely to be treated at a burn center. Patients treated at burn centers appear to have more severe disease but similar mortality to those treated at non-burn centers. Our data suggest that more patients with these disorders could benefit from transfer to a burn center. Applicability of Research to Practice These data may aid in outreach efforts to improve appropriate transfers of patients with severe exfoliative skin disorders to burn centers for definitive care.

Late-onset Stevens–Johnson syndrome due to nivolumab use for hepatocellular carcinoma

2019 ◽  
Vol 25 (8) ◽  
pp. 2052-2055 ◽  
Author(s):  
Constantin A Dasanu
Keyword(s):  
Hepatocellular Carcinoma ◽  
Side Effects ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitor ◽  
Late Onset ◽  
Checkpoint Inhibitor ◽  
Stevens Johnson Syndrome ◽  
Erythematous Rash ◽  
Immunoglobulin G4 ◽  
Johnson Syndrome

Nivolumab is a fully human immunoglobulin G4 immune checkpoint inhibitor antibody approved for use in the treatment of several malignancies. Severe side effects such as Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) have only extremely rarely been reported with this drug. We present herein a patient who developed SJS after 16 weeks of therapy with nivolumab. A week prior to this event, he developed a pruriginous papulo-erythematous rash. Prompt recognition of this phenomenon, immune checkpoint inhibitor discontinuation and steroid therapy are necessary steps in order to avoid dismal outcomes.

Risks associated with lamotrigine prescription: a review and personal observations

2018 ◽  
Vol 26 (6) ◽  
pp. 640-642 ◽  
Author(s):  
Gordon Parker
Keyword(s):  
Quality Control ◽  
Side Effects ◽  
Literature Review ◽  
Dose Escalation ◽  
Poor Quality ◽  
Stevens Johnson Syndrome ◽  
Skin Reactions ◽  
Johnson Syndrome ◽  
Systemic Symptoms ◽  
Epidermal Necrosis

Objectives: To detail some serious lamotrigine side effects and their management, and raise awareness about the possible lack of quality control of some brands of lamotrigine. Methods: A literature review is provided and some personal observations added. Results: While most psychiatrists are aware of the risks of Stevens–Johnson syndrome (SJS), awareness of two other serious side effects – toxic epidermal necrosis (TEN) and drug-related eosinophilia and systemic symptoms (DRESS) – is seemingly lower. Awareness that failure to respond to lamotrigine and that the prevalence of serious side effects may reflect poor quality control of some preparations is also less well recognized. Conclusions: While lamotrigine may be retrialled at a lower dose escalation rate following some skin reactions, it should not be recommenced following a SJS, TEN or DRESS reaction. Prescribers should be aware of quality control concerns about some available brands of lamotrigine.

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