Drug induced toxic epidermal necrolysis: two case reports

Toxic epidermal necrolysis (TEN) is a potentially life-threatening disorder characterized by widespread erythema, necrosis, and bullous detachment of the epidermis and mucous membranes. Without proper management,TEN can cause sepsis leading to death of the patient. Though TEN is commonly drug induced, Isoniazid (INH) has been uncommonly associated with TEN. As INH is one of the first line drugs in treatment of tuberculosis, TEN induced INH needs modification of antitubercular therapy (ATT) with withdrawal of INH from the treatment regime along with other supportive treatments. Patients with HIV infection and disseminated tuberculosis need to be urgently initiated on an effective ATT on diagnosis of tuberculosis. However, if the patient develops potential life-threatening toxicity to first line antitubercular drugs like INH, an alternative effective ATT combination needs to be started as soon as the condition of the patient stabilizes as most of these patients present in advanced stage of HIV infection and this is to be followed by antiretroviral therapy (ART) as per guidelines. The present case reports the effectiveness of an ATT regime comprising Rifampicin, Pyrazinamide, Ethambutol, and Levofloxacin along with ART in situations where INH cannot be given in disseminated tuberculosis in HIV patients.

Download Full-text

T-cell subsets in drug-induced toxic epidermal necrolysis

Archives of Dermatology ◽

10.1001/archderm.128.2.272b ◽

1992 ◽

Vol 128 (2) ◽

pp. 272b-272 ◽

Cited By ~ 2

Author(s):

M. Hertl

Keyword(s):

T Cell ◽

Toxic Epidermal Necrolysis ◽

T Cell Subsets ◽

Drug Induced

Download Full-text

Faculty Opinions recommendation of Drug-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in children: 20 years study in a tertiary care hospital.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726782364.793576497 ◽

2020 ◽

Author(s):

Michele Ramien

Keyword(s):

Toxic Epidermal Necrolysis ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Stevens Johnson Syndrome ◽

Care Hospital ◽

Drug Induced ◽

Johnson Syndrome

Download Full-text

A case of drug-induced hypersensitivity syndrome manifesting as toxic epidermal necrolysis-like skin lesions and severe liver injury

Chinese Journal of Dermatology ◽

10.35541/cjd.20200015 ◽

2020 ◽

Keyword(s):

Liver Injury ◽

Toxic Epidermal Necrolysis ◽

Hypersensitivity Syndrome ◽

Skin Lesions ◽

Severe Liver ◽

Drug Induced

Download Full-text

Proteomic Kinetic Analysis of Blister Fluid and Serum in a Patient with Drug-Induced Toxic Epidermal Necrolysis. A Comparison with Skin Immunohistochemistry

Current Drug Safety ◽

10.2174/1574886311207050003 ◽

2013 ◽

Vol 7 (5) ◽

pp. 339-351

Author(s):

Philippe Paquet ◽

Marie-Alice Meuwis ◽

Gabriel Mazzucchelli ◽

Philippe Delvenne ◽

Gerald E. Pierard

Keyword(s):

Kinetic Analysis ◽

Toxic Epidermal Necrolysis ◽

Blister Fluid ◽

Drug Induced

Download Full-text

Bittersweet: infective complications of drug-induced glycosuria in patients with diabetes mellitus on SGLT2-inhibitors: two case reports

BMC Infectious Diseases ◽

10.1186/s12879-021-05982-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Caroline Bartolo ◽

Victoria Hall ◽

N. Deborah Friedman ◽

Chloe Lanyon ◽

Andrew Fuller ◽

...

Keyword(s):

Diabetes Mellitus ◽

Fungal Infections ◽

Case Reports ◽

Sglt2 Inhibitor ◽

Sglt2 Inhibitors ◽

Urogenital Tract ◽

Hypoglycemic Agents ◽

Drug Induced ◽

First Case ◽

Increased Risk

Abstract Background Sodium-glucose co-transporter 2 (SGLT2) inhibitors are novel hypoglycemic agents which reduce reabsorption of glucose at the renal proximal tubule, resulting in significant glycosuria and increased risk of genital mycotic infections (GMI). These infections are typically not severe as reported in large systematic reviews and meta-analyses of the medications. These reviews have also demonstrated significant cardiovascular benefits through other mechanisms of action, making them attractive options for the management of Type 2 diabetes mellitus (T2DM). We present two cases with underlying abnormalities of the urogenital tract in which the GMI were complicated and necessitated cessation of the SGLT2 inhibitor. Case presentations Both cases are patients with T2DM on empagliflozin, an SGLT2 inhibitor. The first case is a 64 year old man with Candida albicans balanitis and candidemia who was found to have an obstructing renal calculus and prostatic abscess requiring operative management. The second case describes a 72 year old man with Candida glabrata candidemia who was found to have prostatomegaly, balanitis xerotica obliterans with significant urethral stricture and bladder diverticulae. His treatment was more complex due to fluconazole resistance and concerns about urinary tract penetration of other antifungals. Both patients recovered following prolonged courses of antifungal therapy and in both cases the SGLT2 inhibitor was ceased. Conclusions Despite their cardiovascular benefits, SGLT2 inhibitors can be associated with complicated fungal infections including candidemia and patients with anatomical abnormalities of the urogenital tract may be more susceptible to these infections as demonstrated in these cases. Clinicians should be aware of their mechanism of action and associated risk of infection and prior to prescription, assessment of urogenital anatomical abnormalities should be performed to identify patients who may be at risk of complicated infection.

Download Full-text

The toxic effects of chloroquine and hydroxychloroquine on skeletal muscle: a systematic review and meta-analysis

Scientific Reports ◽

10.1038/s41598-021-86079-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Claudia Cristina Biguetti ◽

Joel Ferreira Santiago Junior ◽

Matthew William Fiedler ◽

Mauro Toledo Marrelli ◽

Marco Brotto

Keyword(s):

Systematic Review ◽

Quantitative Analysis ◽

Qualitative Analysis ◽

Observational Studies ◽

Skeletal Muscles ◽

Case Reports ◽

Meta Analysis ◽

Toxic Effects ◽

Drug Induced ◽

Qualitative And Quantitative

AbstractThe aim of this systematic review was to perform qualitative and quantitative analysis on the toxic effects of chloroquine (CQ) and hydroxychloroquine (HCQ) on skeletal muscles. We designed the study according to PRISMA guidelines. Studies for qualitative and quantitative analyses were selected according to the following inclusion criteria: English language; size of sample (> 5 patients), adult (> age of 18) patients, treated with CQ/HCQ for inflammatory diseases, and presenting and not presenting with toxic effects on skeletal muscles. We collected data published from 1990 to April 2020 using PubMed, Cochrane Library, EMBASE, and SciELO. Risk of bias for observational studies was assessed regarding the ROBIN-I scale. Studies with less than five patients (case reports) were selected for an additional qualitative analysis. We used the software Comprehensive Meta-Analysis at the confidence level of 0.05. We identified 23 studies for qualitative analysis (17 case-reports), and five studies were eligible for quantitative analysis. From case reports, 21 patients presented muscle weakness and confirmatory biopsy for CQ/HCQ induced myopathy. From observational studies, 37 patients out of 1,367 patients from five studies presented muscle weakness related to the use of CQ/HCQ, and 252 patients presented elevated levels of muscle enzymes (aldolase, creatine phosphokinase, and lactate dehydrogenase). Four studies presented data on 34 patients with confirmatory biopsy for drug-induced myopathy. No study presented randomized samples. The chronic use of CQ/HCQ may be a risk for drug-induced myopathy. There is substantiated need for proper randomized trials and controlled prospective studies needed to assess the clinical and subclinical stages of CQ/HCQ -induced muscle myopathy.

Download Full-text

Drug-Induced Restless Legs Syndrome

Annals of Pharmacotherapy ◽

10.1177/1060028018760296 ◽

2018 ◽

Vol 52 (7) ◽

pp. 662-672 ◽

Cited By ~ 9

Author(s):

Edna Patatanian ◽

Melanie K. Claborn

Keyword(s):

Restless Legs Syndrome ◽

English Language ◽

Case Reports ◽

Data Extraction ◽

Case Series ◽

Predisposing Factors ◽

Drug Induced ◽

Restless Legs ◽

Drug Classes ◽

Study Selection

Objective: To review the literature on drug-induced restless legs syndrome (DI-RLS). Data Sources: The review included a search for English-language literature from 1966 to December 2017 in the MEDLINE, PubMed, and Ovid databases using the following search terms: restless legs syndrome (RLS), periodic limb movement, adverse effects, and drug-induced. In addition, background articles on the pathophysiology, etiology, and epidemiology of RLS were retrieved. Bibliographies of relevant articles were reviewed for additional citations. Study Selection and Data Extraction: All case reports, case series, and review articles of DI-RLS were identified and analyzed. There were only a small number of controlled clinical trials, and most data were from case reports and case series. Results: Several drugs and drug classes have been implicated in DI-RLS, with antidepressants, antipsychotics, and antiepileptics having the most evidence. In addition, RLS may be linked with a number of disorders or underlying predisposing factors as well. Conclusions: The prevalence of RLS is variable and ranges from 3% to 19% in the general population. There are many predisposing factors to RLS, but an emerging body of evidence suggests that there is an association between numerous drugs and RLS.

Download Full-text