Case Report: Positive Outcome of a Suspected Drug-Associated (Immune Mediated) Reaction in a 4-Year-Old Male French Bulldog

Toxic epidermal necrolysis (TEN) is a rare and severe life-threatening syndrome characterized by apoptosis of keratinocytes resulting in devitalization of the epidermis affecting more than 30% of skin surface. In humans and animals, this condition is mostly triggered by drugs. Identification of the putative agent and its withdrawal are crucial to successful management of a patient with TEN. In this case study, we report the clinical features, histopathological findings and management of a dog with TEN. A 4-year-old intact male French bulldog presented with acute onset of severe lethargy and cutaneous ulcerations on the footpads, scrotum, and hind limbs associated with marked pain. A Stevens-Johnson syndrome/TEN was suspected and drugs, especially beta-lactams, were withdrawn. Histopathology confirmed the diagnosis of epidermal necrosis. Advanced supportive therapy, pain management and skin care led to rapid remission. Early identification and removal of the suspected medication was crucial to improving TEN prognosis in this dog. Antibiotics (penicillin, ampicillin, cephalexin, and sulfonamides) are frequently involved in adverse cutaneous reactions in dogs. Ideal treatment remains elusive is humans and dogs and this disease has a poor prognosis. Supportive care combined with pain management and treatment of the cutaneous ulcerations is essential.

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Commercial Cannabinoid Oil-Induced Stevens-Johnson Syndrome

Case Reports in Ophthalmological Medicine ◽

10.1155/2020/6760272 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Han Y. Yin ◽

Nicholas Hadjokas ◽

Kanish Mirchia ◽

Robert Swan ◽

Samuel Alpert

Keyword(s):

Total Body Surface Area ◽

Supportive Therapy ◽

Maculopapular Rash ◽

Acute Onset ◽

Stevens Johnson Syndrome ◽

Drug Reactions ◽

Drug Induced ◽

Johnson Syndrome ◽

Eye Involvement ◽

Total Body

Purpose. To report an unusual presentation of commercial cannabidiol (CBD) oil-induced Stevens-Johnson Syndrome/toxic epidermal necrolysis (SJS-TEN). Methods. A 56-year-old woman presented with acute onset of a diffuse, blistering, maculopapular rash with over 30% total body surface area (BSA) involvement two days after taking CBD oil sublingually for chronic pain. Biopsy confirmed SJS-TEN. Ophthalmology was consulted and mild eye involvement was found. She was started on topical cyclosporine, prednisone, moxifloxacin, and erythromycin ointment to prevent progression, which was successful. She was otherwise treated with supportive therapy in the intensive care burn unit and ultimately passed away from septic shock. Conclusion. In this case, we described an unusual drug-induced SJS from a commercial, non-FDA-regulated cannabis product. The use of a commercial CBD product should be cautioned due to potential for series of drug reactions to the cannabis product and the risk for reaction to other unregulated other pharmacological components.

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Cephalexin-Induced Stevens-Johnson Syndrome

Annals of Pharmacotherapy ◽

10.1177/106002809202601006 ◽

1992 ◽

Vol 26 (10) ◽

pp. 1230-1233 ◽

Cited By ~ 15

Author(s):

Kim M. Murray ◽

Michael S. Camp

Keyword(s):

Gastrointestinal Tract ◽

Lupus Erythematosus ◽

Skin Surface ◽

Skin Lesions ◽

Infectious Complications ◽

The Body ◽

Stevens Johnson Syndrome ◽

Medline Search ◽

Johnson Syndrome ◽

Macular Rash

OBJECTIVE: To report a case of cephalexin-induced Stevens-Johnson syndrome (SJS), a devastating adverse drug reaction that involves the entire skin surface and mucosal areas of the body. DATA SOURCES: MEDLINE search (key terms cephalosporins, Stevens-Johnson syndrome, erythema multiforme, and systemic lupus erythematosus) and references identified from bibliographies of pertinent articles. DATA SYNTHESIS: Clinical presentation and manifestations of SJS include the skin, eyes, gastrointestinal tract, and pulmonary system. Infectious complications are the leading cause of mortality. Early intervention is important to prevent progression of SJS. The case described is consistent with the features of this syndrome. The patient presented with fever, arthralgias, and malaise. Skin lesions included a diffuse violet macular rash with erythema and multiple bullous lesions on her neck and abdomen. The skin biopsy was consistent with SJS. Multiple mucocutaneous ulcers were found in her mouth, but no evidence of lower gastrointestinal tract involvement was documented. She remained relatively free of pulmonary complaints except for the presenting bronchitis. CONCLUSIONS: Cephalexin should be added to the list of agents to consider as iatrogenic causes of SJS.

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A case report of Stevens-Johnson syndrome and toxic epidermal necrolysis due to diclofenac sodium

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20202955 ◽

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.

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Dual Antiepileptics Induced Stevens-Johnson Syndrome: A Case Report

Journal of Nepal Medical Association ◽

10.31729/jnma.5308 ◽

2020 ◽

Vol 58 (230) ◽

Cited By ~ 1

Author(s):

Prami Nakarmi ◽

Sumit Raut ◽

Siddhartha Manandhar ◽

Abhash Shrestha

Keyword(s):

Case Report ◽

Sodium Valproate ◽

Early Identification ◽

Strong Association ◽

Supportive Therapy ◽

Mortality Rates ◽

Stevens Johnson Syndrome ◽

Erythematous Rash ◽

Disease Spectrum ◽

Johnson Syndrome

Stevens-Johnson syndrome and Toxic Epidermal Necrolysis are acute mucocutaneous reactions hallmark of which is widespread necrosis and detachment of epidermis. SJS/TEN fall under the single disease spectrum with an incidence rate of 1.0 to 6.0 per 1000000 and 0.4 to 1.2 per 1000000 respectively. Here, we present a case of a 46 years female who developed a generalized erythematous rash over her body, 26 days after being exposed to phenytoin and sodium valproate. Given the strong association between SJS and antiepileptic drugs, and the usual presentation being within the first eight weeks of exposure to susceptible medications; we diagnosed her with SJS. Phenytoin and sodium valproate was withdrawn and she was managed with antihistamines and corticosteroids. She improved significantly within 15 days of our intervention. The mortality rates for SJS and TEN are up to 10% and 30-50% respectively. Early identification of SJS, discontinuation of triggering medicines, and prompt initiation of supportive therapy improve the prognosis.

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