Overlapping of Steven-Johnson syndrome and the drug rash with eosinophilia and systemic symptoms during the treatment of carbamazepine

2021 ◽  
Vol 41 (2) ◽  
pp. 115
Author(s):  
Palanisamy Amirthalingam ◽  
OsamaSalih Mohammed ◽  
Abdelrahman BabikerAbdelrahman Osman ◽  
AmirahSalem Alatawi ◽  
HyderOsman Mirghani ◽  
...  
Keyword(s):  
Johnson Syndrome ◽  
Drug Rash ◽  
Steven Johnson Syndrome ◽  
Systemic Symptoms

scholarly journals DRESS Syndrome in a Teenage Male Associated With Hhv-6 Reactivation While on Prolonged TMP-SMX Use

2021 ◽  
Author(s):  
Dalia Conteras ◽  
Iris Pecson ◽  
Alvaro Galvis
Keyword(s):  
Drug Reaction ◽  
Healthcare Providers ◽  
Delay In Diagnosis ◽  
High Clinical Suspicion ◽  
Johnson Syndrome ◽  
Life Threatening ◽  
Steven Johnson Syndrome ◽  
Systemic Symptoms ◽  
Disseminated Disease ◽  
Systemic Drug

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a rare and potentially life-threatening systemic drug reaction with skin involvement. We present the unusual case of DRESS in a 16-year-old male that was treated with TMP-SMX for acne and was initially misdiagnosed with Steven Johnson Syndrome. Our case serves as an example to healthcare providers treating adverse drug reactions to having a high clinical suspicion for DRESS as delay in diagnosis and treatment can result in disseminated disease and higher patient mortality risk.

scholarly journals Insect bite like rash induced by bendamustine – A common presentation with an uncommon cause

2020 ◽  
Vol 11 (e) ◽  
pp. e152.1-e152.5
Author(s):  
Shibani Bhatia ◽  
Ananth Pai ◽  
Raghavendra Rao ◽  
Srilatha Parampalli Srinivas ◽  
Varsha M Shetty
Keyword(s):  
Chemotherapeutic Agent ◽  
Cutaneous Side Effects ◽  
Common Presentation ◽  
Drug Eruptions ◽  
Johnson Syndrome ◽  
Non Hodgkins Lymphoma ◽  
Cutaneous Reactions ◽  
Steven Johnson Syndrome ◽  
Systemic Symptoms ◽  
Favorable Side Effect Profile

Bendamustine has become a popular cancer chemotherapeutic agent in the last couple of years. It has replaced some traditional chemotherapy regimens due to its favorable side effect profile. Various cutaneous side effects have been noted following bendamustine usage. These cutaneous eruptions are to known to occur in 15-24% of patients. Benign cutaneous events include lichenoid drug eruptions, flagellate dermatoses and polymorphic papules and plaques in exposed areas. Rarely, severe adverse cutaneous reactions such as Steven Johnson syndrome, drug rash with eosinophilia and systemic symptoms and toxic epidermal necrolysis have been reported. We report a case of a 48 year-old-female who developed an insect bite like rash after initiation of bendamustine for non-Hodgkins lymphoma.

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

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.

Cutaneous Adverse Drug Reactions (CADRs) between Aromatic and Non-Aromatic Antiepileptic Drugs: Clinical Presentation and Severity

2020 ◽  
Vol 103 (10) ◽  
pp. 1017-1021
Keyword(s):  
Antiepileptic Drugs ◽  
Adverse Drug Reactions ◽  
Drug Hypersensitivity ◽  
Common Adverse Effect ◽  
Drug Reactions ◽  
Johnson Syndrome ◽  
Significant Difference ◽  
Cutaneous Drug Reactions ◽  
Steven Johnson Syndrome ◽  
Systemic Symptoms

Background: Drug hypersensitivity is the most common adverse effect of drug use. Major cutaneous adverse drug reactions (CADRs) represent the higher rates of morbidity and mortality, with up to 5.2% of cases. Current reports revealed the non-aromatic antiepileptic drugs had increasing rates of CADRs from the past. Objective: To study the clinical presentations and the severity of CADRs due to aromatic and non-aromatic antiepileptic drugs. Materials and Methods: A retrospective cohort study was conducted with inpatients and outpatients with CADRs receiving antiepileptic drugs in Phramongkutklao Hospital between January 2009 and December 2018. Results: Among 77 patients with CADRs, 61 patients received aromatic antiepileptic drugs and 16 patients took non-aromatic antiepileptic drugs. Among the patients with aromatic antiepileptic drugs 52.46% developed minor cutaneous drug reactions. The rest, 47.54%, developed major cutaneous drug reactions including Steven-Johnson syndrome or toxic epidermal necrolysis (SJS/TEN) 13.11% and drug rash with eosinophil and systemic symptoms (DRESS) 31.15%. Among the patients with non-aromatic antiepileptic drugs, 62.5% developed minor cutaneous drug reactions. The rest, 37.5%, developed major CADRs including SJS/TEN 12.5% and DRESS 25%. Of the patients receiving aromatic antiepileptic, the major CADRs group showed significant higher level of eosinophil compared with minor CADRs (10.35% and 2.1%, respectively, p<0.001). The study showed significant higher alkaline phosphatase (ALP) levels in 138.5 IU/L among patient with major CADRs who received aromatic antiepileptic drugs compared with minor CADRs in 87 IU/L (p=0.006). No significant difference of laboratory was found among CADRs patients in non-aromatic group. Conclusion: Aromatic antiepileptic drugs tended to cause more severe cutaneous drug reactions than non-aromatic antiepileptic drugs, especially DRESS. The internal organ involvements were significantly identified in the aromatic antiepileptic group regarding to serum eosinophil and ALP level. Keywords: Adverse skin reaction, Aromatic antiepileptic drugs, Non-aromatic antiepileptic drug

scholarly journals Fatal Drug Rash

2019 ◽  
Vol 4 (2) ◽  
pp. 01-03
Author(s):  
Sami L. Bahna ◽  
Diana Munoz-Mendoza ◽  
Neetu Godhwani
Keyword(s):  
Septic Shock ◽  
Drug Reaction ◽  
High Risk ◽  
Stevens Johnson Syndrome ◽  
Johnson Syndrome ◽  
T Cell Stimulation ◽  
Drug Rash ◽  
Systemic Symptoms ◽  
Multiple Drugs ◽  
Prolonged Hospital

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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