scholarly journals Toxic epidermal necrolysis associated with anticonvulsants

2021 ◽  
Vol 14 (3) ◽  
pp. 383-386
Author(s):  
Edinson Dante Meregildo-Rodriguez ◽  
Martha Genera Asmat-Rubio ◽  
Halbert Christian Sánchez-Carrillo ◽  
Frank Poul Chavarri-Troncoso
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Severe Form ◽  
Stevens Johnson Syndrome ◽  
Concomitant Treatment ◽  
Probability Of Survival ◽  
Johnson Syndrome ◽  
Life Threatening ◽  
Medical Emergencies ◽  
Lyell Syndrome ◽  
Causality Evaluation

Background and Objetives: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are considered as a continuum of the same process. TEN or Lyell Syndrome is the most severe form. Both entities involve an acute mucocutaneous blistering reaction associated with systemic inflammation. Materials and Methods: We present a case of a young woman who developed TEN following concomitant treatment with valproate, lamotrigine, and phenobarbital. Despite the extensive mucocutaneous detachment (over 90%), prognostic evaluation was favorable (SCORTEN score 2; probability of survival 88%), and this patient evolved satisfactorily. Five days after admission, valproate was reinitiated without any subsequent adverse reaction. Results: Causality evaluation identified both lamotrigine and phenobarbital as “very probable” (ALDEN score = 6) causes and valproate as “very unlikely” (ALDEN score = 0) cause of TEN. Conclusions: SJS and TEN are true life-threatening medical emergencies. This case emphasizes the importance of early diagnosis and treatment, including the discontinuation of the causative agent, which can be lifesaving.

scholarly journals IVIG and under Burn Unit Care Yield Favorable Outcomes in Pediatric Patients with Toxic Epidermal Necrolysis: A Case Report and Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Tareq Z. Alzughayyar ◽  
Wasim Noureddin Ibrahim Hamad ◽  
Eman A. S. Abuqweider ◽  
Bilal Nabeel Mohammad Alqam ◽  
Sadi A. Abukhalaf ◽  
...  
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Severe Form ◽  
Stevens Johnson Syndrome ◽  
Care Level ◽  
Johnson Syndrome ◽  
Management Protocol ◽  
Burn Unit ◽  
Threatening Condition ◽  
Life Threatening ◽  
Cutaneous Reactions

Body reactions to drugs can manifest as Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). TEN is the most severe form of cutaneous reactions with an incidence rate of 1-2 per million cases per year. Despite TEN being a critical and life-threatening condition, there is little to no evidence of clear management protocol. We reported a 5-year-old male child who presented with lamotrigine-induced TEN and was successfully treated with intravenous immune globulin (IVIG) with a burn unit care level, while TEN treatment with IVIG is an appropriate approach with predictable good outcomes, burn unit care is also effective in creating highly favorable effects. Upon reviewing the literature, several studies indicate that TEN patients treated with the combination of IVIG and burn unit care lead to decreased levels of morbidity and mortality than when treated with IVIG or burn unit care alone. Therefore, treatment involving both IVIG and burn unit care should be considered for TEN 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 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 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.

Toxic Epidermal Necrolysis. A case report

2010 ◽  
Vol 35 (2) ◽  
pp. 197-198 ◽  
Author(s):  
Patricia Villalta ◽  
Ines Velez ◽  
Lina Mejia ◽  
Ana Maria Ospina
Keyword(s):  
Hearing Loss ◽  
Case Report ◽  
Toxic Epidermal Necrolysis ◽  
Immune Reaction ◽  
Extreme Case ◽  
Severe Form ◽  
Stevens Johnson Syndrome ◽  
Johnson Syndrome

We present an extreme case of Toxic Epidermal Necrolysis, which corresponds to a severe form of Stevens Johnson Syndrome. This is a potentially fatal immune reaction that affects skin and mucosa, producing blisters and sloughing of the epithelium. Severe sequelae, including blindness, hearing loss, tooth malformation and esophageal destruction are seen in this case.

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.

scholarly journals Stevens-Johnson syndrome induced by phenytoin: a case report

2016 ◽  
Vol 6 (1) ◽  
pp. 208
Author(s):  
Lalkota Prakash Bhanu ◽  
Kumara Swamy M. ◽  
Mohammed Nasiruddin ◽  
Naveen H. D. ◽  
Rajesh Venkataraman
Keyword(s):  
Adverse Reaction ◽  
Case Report ◽  
Toxic Epidermal Necrolysis ◽  
Antiepileptic Drugs ◽  
Stevens Johnson Syndrome ◽  
Drug Reactions ◽  
Cutaneous Adverse Reaction ◽  
Johnson Syndrome ◽  
Life Threatening ◽  
Grade 3

Stevens-Johnson syndrome (SJS) and Toxic epidermal necrolysis (TEN) are rare (one to two per 10,00,00 population per year) but life threatening adverse drug reactions. Antiepileptic drugs-induced Stevens-Johnson syndrome (SJS) is a life-threatening severe cutaneous adverse reaction, amongst anti-epileptics; carbamazepine and phenytoin are the major culprits. We report here a case of SJS due to phenytoin (CTC vs 2 Grade 3).

scholarly journals The Epidemiology of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in China

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Shang-Chen Yang ◽  
Sindy Hu ◽  
Sheng-Zheng Zhang ◽  
Jin-wen Huang ◽  
Jing Zhang ◽  
...  
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Case Reports ◽  
Statistical Significance ◽  
Epidemiologic Studies ◽  
Stevens Johnson Syndrome ◽  
Systemic Steroid ◽  
China National Knowledge Infrastructure ◽  
Johnson Syndrome ◽  
Life Threatening ◽  
Medical University

Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are life-threatening disease. However, there are only few epidemiologic studies of SJS/TEN from China. To analyze the clinical characteristics, causality, and outcome of treatment for SJS/TEN in China, we reviewed case reports of patients with SJS/TEN from the China National Knowledge Infrastructure (CNKI) and Wanfang database from 2006 to 2016 and patients with SJS/TEN who were admitted to the First Affiliated Hospital of Fujian Medical University during the same period. There were 166 patients enrolled, including 70 SJS, 2 SJS/TEN overlap, and 94 TEN. The most common offending drugs were antibiotics (29.5%) and anticonvulsants (24.1%). Carbamazepine, allopurinol, and penicillins were the most common single offending drugs (17.5%, 9.6%, and 7.2%). Chinese patent medicines accounted for 5.4%. There were 76 (45.8%) patients receiving systemic steroid and intravenous immunoglobulin (IVIG) in combination therapy, especially for TEN (80.3%), and others were treated with systemic steroids alone. Mortality rate of combination treatment comparing with steroid alone in TEN patients had no statistical significance. In conclusion, carbamazepine and allopurinol were the leading causative drugs for SJS/TEN in China. Combination of IVIG and steroids is a common treatment for TEN, but its efficacy in improving mortality needs further investigation.

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.

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