Fatal Drug Rash

We describe the case of a woman presenting with rash and fever 3 weeks after starting oxcarbazepine. She had a convoluted, prolonged hospital course involving reactions to multiple structurally-different medications, with a variety of severe manifestations including drug rash with eosinophilia and systemic symptoms (DRESS), and Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), and complicated with MRSA septic shock and death. This case illustrates the high risk in subjects with a drug reaction that initiated excessive T cell stimulation with subsequent reactions to multiple drugs.

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Early high-dose intravenous corticosteroids rapidly arrest Stevens Johnson syndrome and drug reaction with eosinophilia and systemic symptoms recurrence on drug re-exposure

The Journal of Allergy and Clinical Immunology In Practice ◽

10.1016/j.jaip.2020.08.012 ◽

2020 ◽

Author(s):

Rannakoe J. Lehloenya ◽

Thuraya Isaacs ◽

Tonderai Nyika ◽

Ashar Dhana ◽

Lauren Knight ◽

...

Keyword(s):

Drug Reaction ◽

Stevens Johnson Syndrome ◽

High Dose ◽

Johnson Syndrome ◽

Systemic Symptoms

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Drug Rash with Eosinophilia and Systemic Symptoms versus Stevens-Johnson Syndrome – a Case that Indicates a Stumbling Block in the Current Classification

International Archives of Allergy and Immunology ◽

10.1159/000095437 ◽

2006 ◽

Vol 141 (3) ◽

pp. 308-310 ◽

Cited By ~ 16

Author(s):

Ronni Wolf ◽

Batya Davidovici ◽

Hagit Matz ◽

Keren Mahlab ◽

Edith Orion ◽

...

Keyword(s):

Stevens Johnson Syndrome ◽

Johnson Syndrome ◽

Current Classification ◽

Drug Rash ◽

Systemic Symptoms

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Gene expression profiling in allopurinol-induced severe cutaneous adverse reactions in Vietnamese

Pharmacogenomics ◽

10.2217/pgs-2020-0014 ◽

2020 ◽

Vol 21 (14) ◽

pp. 985-994

Author(s):

Dinh van Nguyen ◽

Hieu Chi Chu ◽

Christopher Vidal ◽

Janet Anderson ◽

Nguyet Nhu Nguyen ◽

...

Keyword(s):

Gene Expression ◽

Expression Profiling ◽

Adverse Reactions ◽

Hypersensitivity Syndrome ◽

Stevens Johnson Syndrome ◽

Johnson Syndrome ◽

Severe Cutaneous Adverse Reactions ◽

Drug Rash ◽

Systemic Symptoms ◽

Cutaneous Adverse Reactions

Aim: To examine gene expression in different clinical phenotypes of allopurinol-induced severe cutaneous adverse reactions (SCARs). Materials & methods: Gene expression profiling was performed using microarray on 11 RNA samples (four controls, three hypersensitivity syndrome/drug rash with eosinophilia and systemic symptoms, four Stevens–Johnson syndrome/toxic epidermal necrolysis) followed by quantitative real-time PCR in a total of 11 SCARs patients and 11 controls. Results: The biological pathways which were significantly enriched in differentially expressed genes in Stevens–Johnson syndrome/toxic epidermal necrolysis compared with hypersensitivity syndrome/drug rash with eosinophilia and systemic symptoms patients included; cell surface interactions at the vascular wall, immunoregulatory interactions at the immunological synapse and MyD88 signaling pathways. Overexpression of miR146a occurred in allopurinol-tolerant HLA-B*58:01 carriers. Conclusion: Biological pathways are identified which appear to be implicated in determining clinical phenotypes in allopurinol-induced SCARs. Overexpression of miR146a is potentially important for allopurinol tolerance in HLA-B*58:01 carriers.

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