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1
Narasimha G., Lakshmi, and Kalpana P. "Amoxicillin induced toxic epidermal necrolysis." International Journal of Basic & Clinical Pharmacology 9, no. 3 (2020): 510. http://dx.doi.org/10.18203/2319-2003.ijbcp20200731.
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Toxic epidermal necrolysis (TEN) is a rare life-threatening adverse drug reaction associated with mucocutaneous eruptions and peeling of skin (sloughing) mostly caused by drugs like sulphonamides, beta lactams, carbamazepine and non-steroidal anti-inflammatory drugs (NSAIDs). Amoxicillin is a broad spectrum, bactericidal, Beta-lactam antibiotic used in treatment of various infections. Here by we have reported the case of amoxicillin induced severe toxic epidermal necrolysis. A Patient admitted in the hospital with the symptoms of epidermal sloughing that resulted in bare dermis as he received Amoxicillin drug for his diagnosis of fever. After clear examination TEN was confirmed and suspected with the cause due to Amoxicillin. The drug was stopped and patient was treated with other drugs for symptomatic cure. The patient was recovered from his condition and improved significantly.
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Udhnawala, Hiren, Hitesh Chaudhari, and Alpa Gor. "AMOXICILLIN+ CLAVULANIC ACID INDUCED TOXIC EPIDERMAL NECROLYSIS (TEN)." Journal of Health Sciences and Professions Education 1, no. 1 (2024): 59. https://doi.org/10.5455/jhspe.20240703060939.
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Amoxicillin, an antibiotic with broad-spectrum bactericidal properties and beta-lactam structure, demonstrates efficacy in treating various infections. Commonly reported adverse reactions include skin rashes and urticaria (3%), vomiting (1%), nausea (3%), diarrhea/loose stools (9%), and vaginitis (1%). According to statistics from the FDA, less than 3% of patients ceased therapy as a result of adverse reactions to their prescribed medications. "The predominant adverse effects linked to penicillin use predominantly involve hypersensitivity responses. Post-marketing surveys have revealed instances of exfoliative dermatitis, including erythema multiforme, pruritus, toxic epidermal necrolysis (TEN), serum sickness-like reactions (urticaria or skin rash accompanied by myalgia, arthritis, fever, and arthralgia), and angioedema." In order to reduce the risks associated with drug use and improve patient safety and welfare, the Pharmacovigilance Program of India (PvPI) was established. The Department of Pharmacology at Pramukh Swami Medical College in Karamsad is one of the ADR Monitoring Centers (AMCs), gathering ADRs as well as case studies and series to inform the public about rare adverse reactions of certain drugs. This case report gives details of a 72 year old Male who developed TEN following the use of the Fixed Dose Combination of Amoxicillin (500mg) + Clavulanic acid (125mg) to treat infection for the epididymo-orchitis. This case report adds and increases need for awareness of rare but serious side effects of Amoxicillin+ Clavulanic acid The report emphasizes on the active ADR monitoring of drugs which may cause serious side effects like TEN
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Mahendra Kumar, R., Sanatkumar Nyamagoud, Krishna Deshpande, and Ankitha Kotian. "Amoxicillin Induced Steven Johnson’s Syndrome: A Case Report." Journal of Drug Delivery and Therapeutics 10, no. 4-s (2020): 220–22. http://dx.doi.org/10.22270/jddt.v10i4-s.4205.
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Stevens-Johnson syndrome (SJS) is a very rare, potentially fatal skin reaction that is typically the result of reaction to the drug. In particular, SJS is characterized by extensive skin and mucous membrane lesions (i.e. mouth, nose, esophagus, anus, and genitalia), epidermis detachment, and acute skin blisters. In 95 % of case reports, drugs were found to be an important cause for the development of SJS. This story is a case of A 42 year old male hospitalized with rashes all over the body and fever, after oral consumption of Amoxicillin drug for sore throat. This case study discusses the possibility that serious hypersensitivity reactions with Amoxicillin can rarely occur and can be extremely harmful and life-threatening Menacing.
 Keywords: Toxic Epidermal Necrolysis, Stevens Johnson Syndrome, Adverse drug reaction, Nikolsky’s sign
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Krishna Kumar, Dhakchinamoorthi, Ravichandran Rajganesh, Dilli Batcha Jaya Shree, Sam Nikhil Cherian, and Thayub Mohamed. "Amoxicillin induced erythematous maculopapular rashes: a case report." International Journal of Basic & Clinical Pharmacology 9, no. 5 (2020): 806. http://dx.doi.org/10.18203/2319-2003.ijbcp20201763.
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Cutaneous adverse reactions (CAR) can occur with any class of drugs, however more widely caused by various antibiotics. Amoxicillin is a broad-spectrum, bactericidal, beta-lactam antibiotic, widely used for combating various infections. Cutaneous drug eruptions are known to be reported common while using penicillin class of drugs, specifically among children. These immune-mediated bizarre drug eruptions were range from mild to severe drug-induced cutaneous reactions, such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). The present case reported with maculopapular, erythematous rashes induced by amoxicillin in a nine-year-old male patient. Amoxicillin was prescribed for his hyperactive respiratory disease and subsequently after three days developed generalized maculopapular erythematous rashes as a result of an antibiotic-induced skin rash. The present case is being reported to add more data, also to emphasize and gather the information for evidence-based practice and to promote efficient pharmacovigilance adverse drug reaction reporting.
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Banday, Muddasir Sharief, Sajad Ahmad Rather, Samina Mufti, and Sabia Qureshi. "Dermatological adverse drug reactions with particular reference to Steven-Johnson syndrome and toxic epidermal necrolysis." Asian Journal of Medical Sciences 14, no. 1 (2023): 104–9. http://dx.doi.org/10.3126/ajms.v14i1.48506.
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Background: Drug therapy is an inevitable cause of cutaneous adverse reactions. Aims and Objectives: The primary aim was to identify the incidence and magnitude of various dermatological adverse reactions including Steven-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Moreover, secondary aim was to quantify the risks associated with the use of specific medications. Materials and Methods: A prospective and hospital-based study was conducted in the department of dermatology SMHS hospital on hospitalized cases of cutaneous adverse drug reactions (CADRs). Informed consent was sought and reactions were reported on validated questionnaire based on adverse drug reaction (ADR) monitoring form provided by Central Drug Standard Control organization Ministry of Health and Family Welfare, Government of India. These dermatological reactions were assessed for the clinical pattern, causative agents, and prognosis. The WHO-Uppsala Monitoring centre system for standardized case was used for causality assessment of all cases identified. Results: A total of 101 hospitalized patients with varied dermatological ADRs were reported during the study period. Cases were found more in females (n=75, 74.25%) than in males (n=26, 25.75%). CADRs that were reported in our study were exanthematous rash, fixed drug eruptions, urticarial rashes, SJS, TEN, urticarial vasculitis, anticonvulsant hypersensitivity syndrome, erythema multiforme, contact dermatitis, exfoliative dermatitis, mucosal hyperpigmentation, and nail pigmentation, respectively. After a meticulous drug history, the drugs implicated in causing the cutaneous reactions were anticonvalscents such as phenytoin, carbamazepine, lamotrigine, and phenobarbitone. Other drugs identified were non-steroidal anti-inflammatory drugs such as oxicam, antibiotics such as sulfasalazine, cefixime, cefpodoxime, amoxicillin, fluoroquinolones such as levofloxacin and ciprofloxacin, chemotherapeutic agents such as cyclophosphamide, 5FU, and hydroxurea. Conclusion: The present study concluded that skin is most common target for ADRs. Drug-induced cutaneous reactions can be as simple as a mild rash to rare life-threatening SJS and TEN. Moreover, certain group of patients is at increased risk for developing CADR’s as women are more susceptible than men.
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Parvathy, Shobha, and Messaline Sunitha. "Pattern of cutaneous adverse drug reactions in an adverse drug monitoring center at a tertiary care hospital in Kerala." National Journal of Physiology, Pharmacy and Pharmacology 13, no. 9 (2023): 434. http://dx.doi.org/10.5455/njppp.2023.13.12610202213012023.
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Background: Pre-marketing clinical trials can filter only about 50% of the drug reaction. Hence, to prevent the morbidity and mortality due to severe cutaneous reactions early detection, evaluation and monitoring of adverse drug reaction (ADR) especially cutaneous ADR (CADR) are mandatory. Hence, it is imperative that we update our knowledge of the precise nature of ADR which will prevent the reactions as well as to find the offending drug. Aim and Objectives: The aim of the study was to evaluate the pattern of CADR, the suspected drugs and to perform the causality assessment using WHO casualty assessment scale. Materials and Methods: A retrospective descriptive study was done using the data reported to ADR monitoring center in the Department of Pharmacology by the health-care professionals. Suspected CADR was diagnosed by the consultants concerned. The CADRs collected were categorized according to their morphology into maculopapupar rash (MPR), fixed drug eruptions (FDE), urticaria, Stevens-Johnson syndrome, and toxic epidermal necrolysis. The causality assessment was done using WHO Causality assessment scale. Results: The mean age was 47.20 + 22.31. The most common CADR reported was Urticaria 65.5% followed MPR 23%, FDE 8.8%, and Steven Johnsons Syndrome 2.2%. Anti-microbial drugs were the most frequent cause of the adverse reactions with Amoxicillin clavulinic acid combination being the most frequent suspected drug producing CADR (13.3%). The WHO causality assessment for majority of CADR was Possible (73.5%). Conclusion: Clinical Patterns of CADRs in this set up have some minor variations when compared to studies done across India. Amoxicillin clavulinic acid is the most common suspected drug in this study which was not frequently reported in other ADR monitoring centers.
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Zyryanov, Sergey, Irina Asetskaya, Olga Butranova, et al. "Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: Analysis of the Russian Database of Spontaneous Reports." Pharmaceuticals 17, no. 6 (2024): 675. http://dx.doi.org/10.3390/ph17060675.
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(1) Background: Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are extremely severe cutaneous adverse drug reactions which are relatively rare in routine clinical practice. An analysis of a national pharmacovigilance database may be the most effective method of obtaining information on SJS and TEN. (2) Methods: Design—a retrospective descriptive pharmacoepidemiologic study of spontaneous reports (SRs) with data on SJS and TEN retrieved from the Russian National Pharmacovigilance database for the period from 1 April 2019 to 31 December 2023. Descriptive statistics was used to assess the demographic data of patients and the structure of suspected drugs. (3) Results: A total of 170 SRs on SJS and TEN were identified, of which 32.9% were SJS and 67.1%—TEN. In total, 30% were pediatric SRs, 21.2%—SRs of the elderly. There were 12 lethal cases, and all cases were TEN. The leading culprit drugs were anti-infectives for systemic use and nervous system agents. The top 10 involved drugs are as follows: lamotrigine (23.5%), ibuprofen (12.9%), ceftriaxone (8.8%), amoxicillin and amoxicillin with beta-lactam inhibitors (8.8%), paracetamol (7.6%), carbamazepine (5.9%), azithromycin (4.1%), valproic acid (4.1%), omeprazole (3.5%), and levetiracetam (3.5%). (4) Conclusions: Our study was the first study in Russia aimed at the assessment of the structure of the drugs involved in SJS and TEN on the national level.
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McDonald, Katherine A., and Tadeusz A. Pierscianowski. "A Case of Amoxicillin-Induced Acute Generalized Exanthematous Pustulosis Presenting as Septic Shock." Journal of Cutaneous Medicine and Surgery 21, no. 4 (2017): 351–55. http://dx.doi.org/10.1177/1203475417701421.
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This case report demonstrates the challenges of diagnosing and managing acute generalized exanthematous pustulosis (AGEP) presenting as septic shock. The disseminated, erythematous, pustular rash is a common feature. However, extensive organ involvement and life-threatening hypotension are unusual. The constellation of signs has not previously been documented following amoxicillin therapy. Toxic epidermal necrolysis (TEN) and toxic shock syndrome (TSS) were considered in addition to AGEP because of the systemic presentation. AGEP was diagnosed following histopathology (TEN was ruled out based on limited necrotic keratinocytes and lack of epidermal necrosis) and a negative antistreptolysin O titer (eliminated TSS). Antibiotic therapy for septic shock was provided before the diagnosis was confirmed as AGEP. Upon confirmation of the AGEP diagnosis, antibiotics were discontinued and a 5-day course of oral prednisone (40 mg/d) was initiated in addition to topical half-strength (0.05%) betamethasone valerate. The patient rapidly improved and was discharged. Outpatient patch testing confirmed amoxicillin as the culprit drug. In conclusion, it is critical to realize that AGEP cannot be ruled out with a septic shock presentation. Recent drug history is critical in recognizing an adverse drug reaction, and patch testing is useful for determining the culpable drug when the diagnosis is AGEP.
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Zanetti, Carlotta. "Wound care in a child suffering from Stevens-Johnson syndrome in PICU: case report." infermieristica journal 3, no. 1 (2024): 9–13. http://dx.doi.org/10.36253/if-2529.
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Stevens-Johnson Syndrome is considered a life-threatening adverse drug reaction. The pathogenesis of these syndromesis still unclear, but several drugs, such as anticonvulsivants and antibiotics, and especially sulfonamides, non-steroidal anti-infiammatorydrugs, and allopurinol were predominantly suspected of triggering this reaction. A 5-year-old boy patient who came to hospital attention for an urticarial reaction developed after taking amoxicillin, then a recent scarlet fever acquired by brother. Due to the worsening of the lesions, he was admitted to our PICU after being intubated for deterioration of the respiratory dynamics and safe treatment of secretions. Nursing care is crucial: care of patient hospitalized with Stevens-Johnson syndrome and Toxic Epidermal Necrolysis consists of wound care, infection prevention, comfort management, hydration and nutrition, psychosocial support, and prevention of long-term complications. For all patients with SJS and TEN, it is essential to perform a total body daily evaluation of the skin. If the dressings remain intact, it is advisable to note the appearance of visible skin and any visible exudate or staining on the outside of the intact dressings. If dressings are being removed or need to be reapplied daily, a full skin evaluation is useful.
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Nurrachmat Mulianto and Lifesia Natali Lidjaja. "Drug-Induced Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Retrospective Study on Causative Agents and Patient Profiles in an Indonesian Hospital Setting." Bioscientia Medicina : Journal of Biomedicine and Translational Research 9, no. 7 (2025): 7967–80. https://doi.org/10.37275/bsm.v9i7.1327.
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Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) represent rare, severe mucocutaneous adverse drug reactions characterized by extensive epidermal necrosis and significant morbidity and mortality. Understanding the specific causative agents and patient profiles within local populations is crucial for early diagnosis and management. This study aimed to characterize SJS/TEN cases in a tertiary hospital setting in Indonesia. Methods: A retrospective descriptive study was conducted using secondary data from medical records of patients diagnosed with SJS, SJS/TEN overlap, and TEN admitted to the inpatient installation of Dr. Moewardi General Hospital, Surakarta, Indonesia, between January 2022 and December 2024. Data collected included demographics (age, gender), comorbidities, diagnosis classification (SJS, SJS/TEN overlap, TEN), suspected causative drugs, length of hospital stay, SCORTEN score, and patient outcome (discharged alive or deceased). Total sampling was employed, excluding records with incomplete data. Data were compiled and analyzed descriptively. Results: Fifty-one patients were included, with a slight female predominance (52.94%). The largest age group affected was 19-59 years (60.78%). The distribution of diagnoses was SJS (41.18%), SJS/TEN overlap (31.37%), and TEN (27.45%). The mean SCORTEN score for the cohort was 2. The most common suspected causative drug classes were antibiotics (25.71%), followed by analgesic-antipyretics (24.29%), and anticonvulsants (22.86%). Carbamazepine (11.43%) and amoxicillin (10%) were frequent individual culprits. Epilepsy (13.73%) and diabetes mellitus (11.76%) were common comorbidities, although a significant portion (33.33%) had no recorded comorbidity. The mean length of stay was 9 days. Overall mortality was 15.68%, with higher rates observed in TEN (28.57%) compared to SJS (9.52%) and SJS/TEN overlap (12.5%). Conclusion: SJS/TEN affected predominantly adults, with antibiotics, analgesics, and anticonvulsants being the most implicated drug classes. While mortality was considerable, it appeared lower than some international reports, particularly for TEN. Recognizing common causative agents and patient risk factors, such as specific comorbidities like epilepsy and diabetes, can aid clinicians in early identification and prompt management of these life-threatening conditions.
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Khadka, Anupa, Punam Mishra, Laxman Chapagain, Manisha Gartaula, Pooja Gupta, and Dwarika Prasad Shrestha. "Clinical Profile and Treatment Outcome of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis at a Tertiary Hospital of Nepal." Nepal Journal of Dermatology, Venereology & Leprology 23, no. 1 (2025): 28–32. https://doi.org/10.3126/njdvl.v23i1.74109.
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Introduction: Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe forms of severe cutaneous adverse reactions (SCAR) with high morbidity and mortality. Due to its rarity and severe acute nature, there is limited data from controlled trials. This study seeks to contribute to the existing knowledge on the etiology and treatment outcomes of SJS/TEN. Objectives: To assess the clinical profile and treatment outcomes of SJS and TEN patients. Materials and Methods: A retrospective analysis of patients’ admissions and discharge records was done from April 2020 to November 2024. The variables analyzed included the clinical types (SJS, TEN, SJS/TEN overlap), causative drugs, treatment undertaken, mean duration of hospital stay, and treatment outcome. Results: Among 27 patients, SJS accounted for 81.48% (n=22), TEN 14.8% (n=4), and SJS/TEN overlapped 3.70% (n=1) of the cases. Non-steroidal anti-inflammatory drugs (NSAIDs) were the most commonly implicated culprit drugs, followed by amoxicillin. The mean time of appearance of the lesion after the medication was 29.14±22.93 days. All the patients received steroids-hydrocortisone 81.48% (n=22); hydrocortisone and dexamethasone 7.40% (n=2) and methylprednisolone 7.40% (n=2) with supportive management. The mean duration of hospital stay was 12.03±10.52 days, and the recovery rate without complication was 88.89% (n=24). Conclusion: SJS is the most common clinical type in the SJS-TEN spectrum. NSAIDs and antibiotics were the common causes of SJS/TEN. Corticosteroids proved beneficial in managing SJS/TEN in our patients.
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Preyra, Rebecca, Lujain Ez Eddin, Fatemeh Ahmadi, Atefeh Jafari, and Flory T. Muanda. "Safety of sulfamethoxazole–trimethoprim for the treatment of bacterial infection in outpatient settings: A systematic review and meta‐analysis with active comparator disproportionality analysis." British Journal of Clinical Pharmacology 91, no. 6 (2025): 1632–48. https://doi.org/10.1111/bcp.70051.
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AimsSulfamethoxazole–trimethoprim (SMX‐TMP) is a widely used antibiotic for treating bacterial infections, but its safety in adult outpatients remains understudied. This systematic review and meta‐analysis evaluated the safety profile of SMX‐TMP and identified critical research gaps. The pharmacovigilance study aimed to validate and extend findings from meta‐analyses to better understand the real‐world safety of SMX‐TMP.MethodsWe searched MEDLINE and Embase up to 12 August 2024, to identify studies comparing adverse drug events (ADEs) following SMX‐TMP vs. other antibiotics in adult outpatients. Meta‐analyses were performed where data allowed. A pharmacovigilance study using the Food and Drug Administration Adverse Event Reporting System was conducted to supplement our findings.ResultsOur review, which included 43 studies, found SMX‐TMP had a nearly 3‐fold higher risk of rash compared to other antibiotics (pooled risk ratio 2.56, 95% confidence interval [1.69, 3.89], I2 = 0%, n = 4458 participants, 24 randomized control trials). Pharmacovigilance data confirmed a higher frequencies of skin disorders and other ADEs compared to various comparator drugs. Compared to azithromycin, SMX‐TMP was associated with a 5‐fold increase in Stevens–Johnson syndrome, a 3‐fold increase in toxic epidermal necrolysis, and a 10‐fold increase in drug reaction with eosinophilia and systemic symptoms. Additionally, SMX‐TMP showed a 10‐fold increase in reports of pancytopenia, a 6‐fold increase in neutropenia, a 4‐fold increase in both thrombocytopenia and aplastic anaemia, a 56‐fold increase in hyperkalaemia, and a 10‐fold increase in hyponatraemia.ConclusionOur meta‐analyses and pharmacovigilance study suggested SMX‐TMP was associated with increased risk of ADEs compared to other antibiotics including amoxicillin/clavulanate, azithromycin and nitrofurantoin. Further robust research is essential to confirm these safety signals and guide clinical practice.
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Shuster, Joel. "Drug-Induced Aseptic Meningitis with Amoxicillin; Restless Legs Syndrome Associated with Escitalopram; Toxic Epidermal Necrolysis with Fluoxetine; Serotonin Syndrome Precipitated by Amantadine Therapy and Renal Failure; Sunitinib and Allergic Interstitial Nephritis; Two Separate Reports of Adverse Drug Reactions with Duloxetine." Hospital Pharmacy 43, no. 4 (2008): 261–64. http://dx.doi.org/10.1310/hpj4304-261.
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Olsen, Debra J., Julienne K. Kirk, and Patricia Flores-Runk. "Adverse Drug Reactions: Drug-Induced Toxic Epidermal Necrolysis." Journal of Pharmacy Practice 7, no. 2 (1994): vi—viii. http://dx.doi.org/10.1177/089719009400700201.
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Racha, Amarthya S., P. Ashwani, and Polevoina Swarnalatha. "Cefditoren pivoxil induced toxic epidermal necrolysis: a case report." International Journal of Research in Dermatology 9, no. 5 (2023): 307–10. http://dx.doi.org/10.18203/issn.2455-4529.intjresdermatol20232550.
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Cutaneous adverse drug reactions vary in severity, from mild erythematous skin lesions to life-threatening toxic epidermal necrolysis. Antiepileptics, antipsychotics, antimicrobials, and diuretics are associated with these adverse reactions. We report a case of cefditoren pivoxil-induced toxic epidermal necrolysis in a 46-year-old Indian woman who presented initially with a maculopapular rash that eventually progressed to steroid-refractory toxic epidermal necrolysis. The patient succumbed to her illness on day 33 of the index rash following septic shock.
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Hasan, Md Jahidul, and Raihan Rabbani. "Intravenous N-acetylcysteine in severe cutaneous drug reaction treatment: A case series." SAGE Open Medical Case Reports 8 (January 2020): 2050313X2093470. http://dx.doi.org/10.1177/2050313x20934708.
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Drug-induced serious adverse reaction is an unpleasant event with high rate of mortality. Stevens–Johnson Syndrome and toxic epidermal necrolysis are most common among the serious adverse drug reactions. There is no selective drug therapy for the management of serious adverse drug reactions-associated mucocutaneous blisters. The use of N-acetylcysteine in the treatment of mucocutaneous blisters has limited evidence worldwide. Three cases of toxic epidermal necrolysis or Stevens–Johnson Syndrome-associated mucocutaneous blisters are presented in this study where intravenous N-acetylcysteine (600 mg, every 8 h) was given in early hospitalization hours for the treatment of mucocutaneous fluid-filled blisters. Here, one patient with toxic epidermal necrolysis received intravenous immunoglobulin along with intravenous N-acetylcysteine and the other two patients (toxic epidermal necrolysis/Stevens–Johnson Syndrome) received only N-acetylcysteine intravenously. In response, mucocutaneous fluid-filled blisters stopped progressing within 48 h and were healed within 2 weeks of admission in the intensive care unit. Thus, intravenous N-acetylcysteine with or without having intravenous immunoglobulin in the treatment of serious adverse drug reactions-associated mucocutaneous blisters may be an effective therapeutic option for better clinical outcome.
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Datta, Ananda, Raghavendrun Sivasankar, and Bikash Ranjan Kar. "Pyrazinamide-induced Toxic Epidermal Necrolysis." Annals of African Medicine 23, no. 3 (2024): 494–95. http://dx.doi.org/10.4103/aam.aam_161_23.
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The antitubercular drugs are associated with different cutaneous adverse drug reactions. Toxic epidermal necrolysis (TEN) is a severe form of cutaneous reaction. Although it is rare, it carries a high mortality rate. We report a case of a 75-year-old man with abdominal tuberculosis, who developed pyrazinamide-induced TEN.
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Joarder, Lili, Lopamudra (Dhar) Chowdhury, Koustuv Chowdhury, Sanjit Mal, and Abhik Saha. "Methotrexate induced Toxic Epidermal Necrolysis in a Rheumatoid Arthritis Patient: A Case Report." International Journal of Science and Healthcare Research 10, no. 1 (2025): 256–58. https://doi.org/10.52403/ijshr.20250134.
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Methotrexate (MTX), a folate antagonist, is a first-line disease-modifying antirheumatic drug (DMARD) used in the treatment of Rheumatoid arthritis (RA), a chronic autoimmune disorder characterized by synovial inflammation and joint destruction1. Despite its efficacy, MTX is associated with severe adverse drug reactions (ADRs), which are classified as Type B reactions—idiosyncratic or hypersensitivity reactions that are unpredictable and often dose-independent. Toxic epidermal necrolysis (TEN), a rare but life-threatening ADR, is a severe mucocutaneous condition characterized by extensive epidermal detachment and mucosal erosions, often triggered by medications. This case highlights the potential for MTX to induce TEN, hepatic failure, and renal failure, emphasizing the critical need for vigilant monitoring, early recognition, and prompt management of MTX toxicity, particularly in high-risk populations with comorbidities Adverse drug reaction was reported to Adverse drug reaction monitoring centre (AMC) and severity was assessed by WHO-UMC Scale. Patient died after 3 days of admission. Score of Toxic epidermal necrolysis (SCORTEN Scale) is used to assess severity of the illness and to predict mortality4.Early diagnosis, withdrawal of offending agent& timely proper supportive management can help in lowering the mortality. Keywords: Methotrexate, Toxic Epidermal Necrolysis, Rheumatoid Arthritis, Adverse Drug Reaction, Hepatic Failure, Renal Failure.
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S., M. Biradar, Indu Pathi, and P. Ambali Anand. "PHENYTOIN INDUCED TOXIC EPIDERMAL NECROLYSIS: A CASE REPORT." International Journal of Medical Research and Pharmaceutical Sciences 4, no. 9 (2017): 1–5. https://doi.org/10.5281/zenodo.886071.
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The drug induced Toxic epidermal necrolysis (TEN) is an acute emergency and is potentially life threatening if not treated promptly. It is obvious that patients with TEN demand much more meticulous and aggressive therapy for better outcome. Adverse drug reactions (ADRs) are one of the most leading causes of death among hospitalized patients; these may vary from mild rashes to severe reactions such as Stevens-Johnson syndrome (SJS) and Toxic epidermal necrolysis. Though the Phenytoin is an anti-epileptic drug, there is increased risk of TEN and other skin related problems. Thus utmost care should be taken while handling with the Phenytoin.
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Monteiro, Ana Filipe, Margarida Rato, and César Martins. "Vemurafenib-Induced Toxic Epidermal Necrolysis: An Emerging Adverse Event." Journal of the Portuguese Society of Dermatology and Venereology 76, no. 3 (2018): 329–32. http://dx.doi.org/10.29021/spdv.76.3.926.
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Vemurafenib, a selective inhibitor of the BRAF V600 mutation, is Food and Drug Administration and European Medicines Agency approved for the treatment of stage IV metastatic melanoma alone or in combination. Among the adverse effects, cutaneous toxicity is the most common. Most of these reactions such as maculopapular rash, photosensitivity and hyperkeratotic lesions are manageable, and the majority of patients are able to continue therapy. However, a few cases of life-threatening severe cutaneous adverse reactions have been reported and drug withdrawal is mandatory in these cases. Herein, we report a case of vemurafenib- -induced toxic epidermal necrolysis in a patient receiving therapy for metastatic melanoma. After several hospital complications, our patient survived to the drug-induced reaction and he is in remission for 2 years.
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Fakoya, Adegbenro Omotuyi John, Princess Omenyi, Precious Anthony, et al. "Stevens - Johnson Syndrome and Toxic Epidermal Necrolysis; Extensive Review of Reports of Drug-Induced Etiologies, and Possible Therapeutic Modalities." Open Access Macedonian Journal of Medical Sciences 6, no. 4 (2018): 730–38. http://dx.doi.org/10.3889/oamjms.2018.148.
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Stevens - Johnson Syndrome and Toxic Epidermal Necrolysis are adverse hypersensitivity reactions that affect the skin and mucous membranes. They are characterised by erythematous macules and hemorrhagic erosions of the mucous membranes. Epidermal detachments of varying degrees of severity also occur in these conditions. Various aetiologies are associated with these conditions, with adverse drug reaction being the most common. Though the worldwide incidence of these conditions is recorded as low, diverse types of medication are being observed to lead to these conditions. This review compiles information on the details of Stevens-Johnson syndrome and Toxic Epidermal Necrolysis, the pathophysiology, therapeutic management, and largely considers the drug-induced etiologies associated with these conditions.
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Kumar, Vineet, Manju Gari, Kishor Chakraborty, Ravi Ranjan, Anshuman Chandra, and Kavita Kumari. "Nimesulide induced toxic epidermal necrolysis: a rare case report." International Journal of Basic & Clinical Pharmacology 6, no. 12 (2017): 2939. http://dx.doi.org/10.18203/2319-2003.ijbcp20175223.
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Adverse drug reactions to the prescribed medicines are the major obstacles in continuation of drug treatment. Nimesulide, a selective cyclo-oxygenase (COX-2) inhibitor was first launched in Italy in 1985 and subsequently marketed in more than 50 countries including India. Due to its better and faster antipyretic action, it has gained popularity among physicians and paediatricians. Here, we report a case of 60 years old male patient who developed toxic epidermal necrolysis (TEN) following ingestion of tablet nimesulide. The patient was managed with parenteral corticosteroids, antibiotics, emollients, anti-fungal and supportive care. This case highlights the importance of nimesulide and other NSAIDs as possible cause of TEN. Nimesulide has never been approved in countries like USA, Canada, Britain, New Zealand, Australia. But in India it is available as over the counter drug and is used for various indications like fever, myalgia, arthralgia. Therefore, the drugs which are banned outside India should be used with caution and medical practitioners should report all the adverse drug reactions to such drugs.
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Lee, Eun Hye, and Yong Hyun Jang. "Cutaneous adverse drug reactions." Journal of the Korean Medical Association 66, no. 1 (2023): 41–47. http://dx.doi.org/10.5124/jkma.2023.66.1.41.
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Background: Cutaneous adverse drug reactions are common and produce easily identifiable clinical symptoms. These may range from mild maculopapular rashes to severe reactions associated with systemic disease.Current Concepts: The most common presentation of a drug eruption is in the form of a maculopapular rash or exanthematous skin eruption, followed by fixed drug eruptions and urticaria. Severe cutaneous adverse drug reactions include Stevens-Johnson syndrome/toxic epidermal necrolysis, acute generalized exanthematous pustulosis, and drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms, which are rare but potentially life-threatening. Recently, it has emerged that cutaneous adverse drug reactions associated with newly developed drugs, such as epidermal growth factor receptor inhibitors, may induce a variety of cutaneous manifestations.Discussion and Conclusion: Although certain drugs, such as antimicrobials and anticonvulsants, can frequently cause drug eruptions, their effects may change, depending on the situation and timing. Therefore, in order to resolve symptoms and prevent complications, early diagnosis, drug identification, and appropriate treatment should be performed, in consideration of the various factors involved.
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Langlois, Michael R., Francis Derk, Ronald Belczyk, and Thomas Zgonis. "Trimethoprim-Sulfamethoxazole–Induced Stevens-Johnson Syndrome." Journal of the American Podiatric Medical Association 100, no. 4 (2010): 299–303. http://dx.doi.org/10.7547/1000299.
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Stevens-Johnson syndrome and toxic epidermal necrolysis are rare; however, when they occur, they usually present with severe reactions in response to medications and other stimuli. These reactions are characterized by mucocutaneous lesions, which ultimately lead to epidermal death and sloughing. We present a unique case report of Stevens-Johnson syndrome and associated toxic epidermal necrolysis in a 61-year-old man after treatment for a peripherally inserted central catheter infection with trimethoprim-sulfamethoxazole. This case report reviews a rare adverse reaction to a commonly prescribed antibiotic drug used in podiatric medical practice for the management of diabetic foot infections. (J Am Podiatr Med Assoc 100(4): 299–303, 2010)
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Ramien, Michele, and Jennifer L. Goldman. "Pediatric SJS-TEN: Where are we now?" F1000Research 9 (August 13, 2020): 982. http://dx.doi.org/10.12688/f1000research.20419.1.
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Stevens–Johnson syndrome and toxic epidermal necrolysis are rare severe blistering skin reactions triggered by medications or infections. Over the last 5 to 10 years, a number of important publications have advanced understanding of these diseases and their response to treatment. Importantly, a subset of patients with disease triggered by infection has been identified as having Mycoplasma pneumoniae–induced rash and mucositis, suggesting a reconsideration of the diagnostic paradigm. We present an update on pediatric Stevens–Johnson syndrome and toxic epidermal necrolysis in the broader context of cutaneous adverse drug reactions and focus on challenges and recent advances in diagnosis, management, and prevention.
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Yoshioka, Manabu, Yu Sawada, and Motonobu Nakamura. "Diagnostic Tools and Biomarkers for Severe Drug Eruptions." International Journal of Molecular Sciences 22, no. 14 (2021): 7527. http://dx.doi.org/10.3390/ijms22147527.
Full textAbstract:
In accordance with the development of human technology, various medications have been speedily developed in the current decade. While they have beneficial impact on various diseases, these medications accidentally cause adverse reactions, especially drug eruption. This delayed hypersensitivity reaction in the skin sometimes causes a life-threatening adverse reaction, namely Stevens-Johnson syndrome and toxic epidermal necrolysis. Therefore, how to identify these clinical courses in early time points is a critical issue. To improve this problem, various biomarkers have been found for these severe cutaneous adverse reactions through recent research. Granulysin, Fas ligands, perforin, and granzyme B are recognized as useful biomarkers to evaluate the early onset of Stevens-Johnson syndrome and toxic epidermal necrolysis, and other biomarkers, such as miRNAs, high mobility group box 1 protein (HMGB1), and S100A2, which are also helpful to identify the severe cutaneous adverse reactions. Because these tools have been currently well developed, updates of the knowledge in this field are necessary for clinicians. In this review, we focused on the detailed biomarkers and diagnostic tools for drug eruption and we also discussed the actual usefulness of these biomarkers in the clinical aspects based on the pathogenesis of drug eruption.
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West, Dennis P., and Jean A. Rumsfield. "Cutaneous Manifestations of Adverse Drug Reactions." Journal of Pharmacy Practice 2, no. 4 (1989): 251–55. http://dx.doi.org/10.1177/089719008900200409.
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immune-mediated cutaneous reactions to drugs are usually categorized into four distinct types: Type 1, immediate; Type 11, cytotoxic; Type III, immune-complex: and Type IV, cell-mediated. Nonimmunologic skin reactions are also recognized. Beyond immune vnonimmune classifications, cutaneous drug reactions are generally described according to morphologic patterns of reaction. Common types of reactivity usually include maculopapular and urticarial eruptions. In addition, less common reactions include fixed drug eruption, hyperpigmentation, vasculitis, erythema multiforme, toxic epidermal necrolysis, photosensitivity, and alopecia. The drugs most frequently associated with these reactions can be identified and the pharmacist, by accomplishing a thorough systematic drug history, may play a significant role in determining likelihood of drug cause.
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Breshkovska, Hristina, Silvija Duma, Suzana Nikolovska, et al. "Toxic Epidermal Necrolysis: Case Report and Review." South East European Journal of Immunology 7 (March 12, 2024): 56–60. http://dx.doi.org/10.3889/seejim.2024.6075.
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BACKGROUND: Stevens–Johnson syndrome and toxic epidermal necrolysis (TEN) are severe mucocutaneous adverse drug reactions primarily caused by drugs. Characterized by fever, prodromal symptoms, and extensive epidermal sloughing with mucous membrane involvement (>90%), they are collectively termed epidermal necrolysis and are considered a disease continuum. CASE PRESENTATION: A 65-year-old man presented with widespread erythema and distinctive target-like lesions, accompanied by ruptured flaccid vesicles on the extremities. Following a 4-week carbamazepine treatment for a previous cerebrovascular insult, hematological analysis revealed abnormalities. A multidisciplinary team, including a neurologist, endocrinologist, and ophthalmologist, prescribed a 3-day course of intravenous immunoglobulin at 0.5 g/kg and an initial dose of 300 mg prednisolone for 3 days, supported by additional therapy. Discharged after 3 weeks, the rash completely resolved within 2 months. CONCLUSION: TEN, a severe mucocutaneous condition with a 30% mortality rate, often results from drug exposure. Swift identification of the causative drug is crucial for optimal outcomes. Treatment primarily includes discontinuing the offending drug and offering supportive care for mucocutaneous lesions. A multidisciplinary approach is vital based on organ system involvement. The effectiveness of pharmacological treatments, such as intravenous immunoglobulin and corticosteroids, is continually under evaluation.
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Kinoshita, Manao, Youichi Ogawa, Natsumi Hama, et al. "Neutrophils initiate and exacerbate Stevens-Johnson syndrome and toxic epidermal necrolysis." Science Translational Medicine 13, no. 600 (2021): eaax2398. http://dx.doi.org/10.1126/scitranslmed.aax2398.
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Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening mucocutaneous adverse drug reactions characterized by massive epidermal detachment. Cytotoxic T cells and associated effector molecules are known to drive SJS/TEN pathophysiology, but the contribution of innate immune responses is not well understood. We describe a mechanism by which neutrophils triggered inflammation during early phases of SJS/TEN. Skin-infiltrating CD8+ T cells produced lipocalin-2 in a drug-specific manner, which triggered the formation of neutrophil extracellular traps (NETs) in early lesional skin. Neutrophils undergoing NETosis released LL-37, an antimicrobial peptide, which induced formyl peptide receptor 1 (FPR1) expression by keratinocytes. FPR1 expression caused keratinocytes to be vulnerable to necroptosis that caused further release of LL-37 by necroptotic keratinocytes and induced FPR1 expression on surrounding keratinocytes, which likely amplified the necroptotic response. The NETs-necroptosis axis was not observed in less severe cutaneous adverse drug reactions, autoimmune diseases, or neutrophil-associated disorders, suggesting that this was a process specific to SJS/TEN. Initiation and progression of SJS/TEN keratinocyte necroptosis appear to involve a cascade of events mediated by innate and adaptive immune responses, and understanding these responses may contribute to the identification of diagnostic markers or therapeutic targets for these adverse drug reactions.
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van Nguyen, Dinh, Hieu Chi Chu, Christopher Vidal, et al. "Gene expression profiling in allopurinol-induced severe cutaneous adverse reactions in Vietnamese." Pharmacogenomics 21, no. 14 (2020): 985–94. http://dx.doi.org/10.2217/pgs-2020-0014.
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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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Kandolf-Sekulović, Lidija, and Tatjana Radević. "Cutaneous Adverse Drug Reactions / Dematološka neželjena dejstva lekova." Serbian Journal of Dermatology and Venerology 4, no. 2 (2012): 61–76. http://dx.doi.org/10.2478/v10249-012-0005-8.
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Abstract Adverse drug reactions may be defined as undesirable clinical manifestations resulting from administration of a particular drug; this includes reactions due to overdose, predictable side effects, and unanticipated adverse manifestations. Adverse drug effects on the skin are among the most frequent reactions and, according to a study, account for approximately 14% of all adverse drug reactions. However, the incidence of cutaneous adverse effects in general population is unknown. Systemic drug administration results in various cutaneous adverse reactions, and medications used in the treatment of skin diseases themselves have their own adverse effects. Adverse drug reactions include a wide range of effects, from harmless exanthema of short duration, urticaria to systemic cutaneous reactions such as drug rash with eosinophilia and systemic symptoms (DRESS) or toxic epidermal necrolysis. Exanthematous eruptions and urticaria are the two most common forms of cutaneous drug reactions. Less common include fixed eruptions, lichenoid, pustular, bullous and vasculitis reactions. The most severe cutaneous and mucosal adverse drug reactions are epidermal necrolysis, which is usually drug-induced, DRESS syndrome, and acute generalized exanthematous pustulosis. Therefore, the diagnostic of adverse drug reactions requires a detailed history of drug intake and development of skin disorders, excellent knowledge of clinical presentations for a wide range of drug-induced skin reactions as well as of the very medications being taken by patients. In addition to details on drug intake, it is necessary to learn about taking herbal and alternative preparations, which may also cause adverse reactions. A drug started within 6 weeks of the development of disorders is considered the most common cause of adverse reaction, as well as drugs taken periodically but regularly. Once a reaction has occurred, it is important to prevent future similar reactions with the same drug or a cross-reacting medication. Early withdrawal of all potentially responsible drugs is essential, particularly in case of severe drug reactions.
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Deep, Hardeep S., Mohit Kumar, Barjinder Pal Singh, and Nisha Kajla. "Piperacillin/tazobactam induced toxic epidermal necrolysis and drug induced liver injury." International Journal of Advances in Medicine 5, no. 2 (2018): 460. http://dx.doi.org/10.18203/2349-3933.ijam20181091.
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The liver and skin are the organs most commonly involved in serious adverse drug reactions. Rarely a drug reaction can affect both organs concurrently. The association of drug induced liver injury (DILI) and toxic epidermal necrolysis (TEN) is even rarer and may be rarely reported. This is a case report on development of both TEN and DILI following use of piperacillin / tazobactam. We describe our experience of DILI occurring in association with TEN including the etiological agent responsible, its clinical/ biochemical characteristics and ultimate outcome.
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Rao, Munnaluri Mohan, Kotha Raghupathi Reddy, and Chittla Sravan. "Comparison of Clinico-Epidemiological Features of Cutaneous Adverse Drug Reactions." Journal of Evidence Based Medicine and Healthcare 7, no. 44 (2020): 2550–56. http://dx.doi.org/10.18410/jebmh/2020/527.
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BACKGROUND Cutaneous adverse drug reactions are an important group of disorders which pose considerable amount of diagnostic and therapeutic challenges. The incidence of CADRs is estimated to be 1 - 2 % in the general population. We wanted to compare the clinico-epidemiological features of cutaneous adverse drug reactions in children and adults. METHODS The study sample comprised of two hundred and twenty patients of CADRs over a period of one and a half years. Patients were assessed using the WHO based algorithm of causality assessment of adverse drug reactions. RESULTS 222 rashes were seen in 220 patients and 315 drugs were implicated. The incidence of CADRs among dermatology patients was 10.18 per thousand patients. The incidence of CADRs among adults and children was 10.15 and 10.34 per thousand patients respectively. Out of the two hundred and twenty cases, thirty five (15.9 %) were in the paediatric age group (< 18 years of age). The most common cutaneous adverse drug reaction seen in our patients was maculopapular rash which was seen in 22 % patients. Antimicrobials were found to be the most common cause of CADRs in both adults and children, while drugs acting on the central nervous system were a close second. When rashes were taken individually, antimicrobials were the most common cause of maculopapular reactions, urticaria and toxic epidermal necrolysis in both children and adults. Acneiform eruptions were caused by steroids in 82 % of cases. Although fixed drug eruptions were most commonly caused by antimicrobials in adults (especially quinolones and nitroimidazoles), NSAIDs particularly nimesulide was also implicated in a substantial number of cases. CONCLUSIONS Newer antibiotics like cephalosporins are being used more often and thus a higher number of adverse drug reactions are seen with them. Therefore it would be useful for every individual institution to maintain a drug reaction registry. KEYWORDS Cutaneous Adverse Drug Reaction, Maculopapular Reactions, Urticaria, Toxic Epidermal Necrolysis
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Rozenbajgier, Martyna, Justyna Wójcik-Grudzień, Paulina Pawłowska, and Alicja Ozga-Stachurska. "Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis, A Review of Pathogenesis, Clinical Features, Diagnosis and Treatment." Journal of Education, Health and Sport 12, no. 9 (2022): 512–18. http://dx.doi.org/10.12775/jehs.2022.12.09.060.
Full textAbstract:
Stevens Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, acute conditions, potentially life-threatening, immune-mediated and often unpredictable.
 Characteristic for SJS and TEN is acute necrosis of the epidermis and mucous membranes, caused by the extensive death of keratinocytes. These syndromes are considered hypersensitivity reactions. They are most often caused by drugs. There have also been reports of SJS / TEN being caused by infection,
 SJS/TEN disease is very rare and due to its rarity there is no specific pharmaceutical algorythm. Supportive care and treatment of symptoms are very important. The most crucial part of non-pharmacologic treatment of SJS/TEN is the detection and cessation of the pharmaceutical that caused the disease.
 The aim of this literature review was to summarize current knowledge about the pathogenesis, clinical features, diagnosis and treatment of Stevens- Johnson Syndrom and Toxic Epidermal Necrolysis.
 Standard criteria were used to review the literature data. The search of articles in the PubMed and Google Scholar database was carried out using the following keywords: Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis, cutaneous adverse drug reactions
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Bhanu, Lalkota Prakash, Kumara Swamy M., Mohammed Nasiruddin, Naveen H. D., and Rajesh Venkataraman. "Stevens-Johnson syndrome induced by phenytoin: a case report." International Journal of Basic & Clinical Pharmacology 6, no. 1 (2016): 208. http://dx.doi.org/10.18203/2319-2003.ijbcp20164781.
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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).
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Maitra, Aditi, Shashwat Bhattacharyya, Shatavisa Mukherjee, and Nikhil Era. "A rare case of oxcarbazepine induced Stevens Johnson Syndrome: toxic epidermal necrosis overlap." International Journal of Basic & Clinical Pharmacology 6, no. 2 (2017): 466. http://dx.doi.org/10.18203/2319-2003.ijbcp20170350.
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Oxcarbazepine is a closely related analogue of carbamazepine and is useful in the monotherapy of seizures with an improved toxicity profile. Its clinical safety has been recently put under scrutiny as evidence has emerged about its adverse drug reactions and it is increasingly being reported to cause cutaneous drug eruptions. Here we report a rare case of oxcarbazepine induced Stevens Johnson - toxic epidermal necrolysis overlap.
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Preclaro, Ivan Arni Caballero, Kristine Ida L. Liwag, Michaela Tabalon-Morales, and Ma Corazon Iniego-Rodas. "Severe Cutaneous Adverse Reactions: A Narrative Literature Review." Journal of the Philippine Dermatological Society 33, no. 2 (2024): 67–79. https://doi.org/10.4103/jpds.jpds_38_24.
Full textAbstract:
Severe cutaneous adverse reactions (SCAR) are the rare conditions associated with medication use. This includes Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis and generalized bullous fixed drug eruption. These diseases present with various vivid cutaneous manifestations associated with systemic symptoms and may cause potential mortality. It is classified as a delayed-type hypersensitivity with different cell mediators depending on its clinical phenotype. Genetic factors seem to have a role in the interaction of the culprit drug and the host’s immune system. This narrative review aims to describe the clinical manifestations of different SCAR, to review its pathomechanism, diagnosis and management, and to stipulate its future directions in the Philippines.
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Kandolf-Sekulović, Lidija. "An update on diagnosis and treatment of toxic epidermal necrolysis / Novine u dijagnostici i lečenju toksične epidermalne nekrolize." Serbian Journal of Dermatology and Venerology 3, no. 2 (2011): 53–64. http://dx.doi.org/10.2478/v10249-011-0037-5.
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Abstract Toxic epidermal necrolysis is an idiosyncratic drug reaction which manifests with extensive epidermal detachment due to the massive keratinocyte apoptosis, mucous membrane involvement, and potentially lethal outcome. It is caused by adverse reactions to drugs, mostly idiosyncratic, unpredictable and independent of the applied dose, which develops 7-21 days after initiation of the drug, and is most commonly caused by the following drugs: sulfonamides, allopurinol, carbamazepine, phenobarbitone, phenytoin and oxycam group of nonsteroidal anti-inflammatory drugs. The treatment outcome depends on several factors, while older age, multiple drug use, late exclusion of the drug inducing toxic epidermal necrolysis, raised serum levels of urea, creatinine and cytopenia are poor prognostic indicators which are rated in SCORTEN scoring which proved to be of great help in the assessment of disease outcome. The basic approach to the treatment is early diagnosis, immediate suspension of the probable inducing drug, and emergency transport to the closest burn center, since treatment in burn units is associated with a lower risk of infection and mortality of these patients. Exclusion of the drug that induced toxic epidermal necrolysis, and supportive therapy, is the first and only therapy for which there is a consensus in different centers. Various forms of adjuvant therapy are also applied: in France, supportive therapy is a standard of care, in Germany it is short-term use of high-dose corticosteroids, while in USA, in the last decade high-dose intravenous immunoglobulins are the most widely accepted treatment modalities. Case reports and small patients’ series described therapeutic effects of plasmapheresis, cyclosporine and other immunosuppressants. In conclusion, elimination of the possible causal agent, rapid transport to the burn unit, and multidisciplinary approach to treatment are of utmost importance for favorable outcome of the disease with 20-30% mortality rate. An update on diagnosis and the treatment of toxic epidermal necrolysis is provided in this review.
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Laskar, Jahirul Islam, Pinaki Chakravarty, and Babul Dewan. "TOXIC EPIDERMAL NECROLYSIS INDUCED BY CARBAMAZEPINE: A CASE STUDY." Asian Journal of Pharmaceutical and Clinical Research 10, no. 7 (2017): 78. http://dx.doi.org/10.22159/ajpcr.2017.v10i7.18406.
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Objectives: The objective of this case study is to evaluate the importance of detection, assessment, and reporting of an adverse drug reaction and to improve the medication perseverance. Methods: This is an observational type of case report which was observed and analyzed in Silchar Medical College and Hospital on regular ward rounds. Results: A case report of toxic epidermal necrolysis due to carbamazepine (CBZ) administration by a 47-year-old male patient who presented as a follow-up case of ischemic stroke. Causality assessment of the event done with Naranjo’ causality assessment scale suggests to be “Probable.” Conclusion: Daily, CBZ is being increasingly prescribed for control of pain in neuralgias and diabetic neuropathy, apart from control of seizures. Awareness about the drugs implicated in life-threatening drug reactions will help physicians in preventing them by cautious use of the drugs. Moreover, proper counseling to the patient regarding the use of medications is of utmost importance, in such life-threatening conditions where treatment guidelines remain indistinct.
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T. Amul Prathap, D.G. Abinish, S. Kalaivani, D. Lokeshvaran, and J. Aswin. "Acyclovir Induced Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis - A Rare Case Report." Indian Journal of Forensic Medicine & Toxicology 19, no. 1 (2024): 18–23. https://doi.org/10.37506/385gxd65.
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Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis are serious, life-threatening conditions often triggered by drug reactions, characterized by widespread skin detachment and mucosal involvement. This case report describes a 29-year-old woman who developed Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis after receiving prophylactic acyclovir for suspected herpes. The patient initially presented with oral ulcers that rapidly progressed to widespread blisters, ulcers, and severe skin peeling. A thorough diagnostic evaluation, including skin biopsy and the Naranjo algorithm, identified acyclovir as the causative agent. The patient was managed in intensive care with intravenous methylprednisolone 500mg per day for 3 consecutive days as pulse therapy, antibiotics, and other supportive treatments. This case underscores the importance of early recognition, prompt discontinuation of the offending drug, and a multidisciplinary treatment approach. It also highlights the critical need for heightened awareness among healthcare professionals regarding the potential for severe adverse reactions with commonly used medications like acyclovir, to improve patient safety and outcomes.
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Kulkarni, Shambhavi, and A. N. Dattatri. "Phenytoin induced Stevens-Johnson syndrome: a case report." International Journal of Basic & Clinical Pharmacology 7, no. 3 (2018): 573. http://dx.doi.org/10.18203/2319-2003.ijbcp20180676.
Full textAbstract:
Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are rare but potentially life threatening cutaneous adverse drug reactions. Drugs commonly implicated are anti-microbials, anti-epileptics and non-steroidal anti-inflammatory drugs (NSAIDs). Amongst anti-epileptics, carbamazepine and phenytoin are the most common offending drugs. We report here a case of SJS due to phenytoin.
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Flor, Duarte, Mariana Pedroso, Inês Coutinho, and Margarida Gonçalo. "Toxic epidermal necrolysis caused by vemurafenib in a metastatic malignant melanoma." BMJ Case Reports 18, no. 2 (2025): e263057. https://doi.org/10.1136/bcr-2024-263057.
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Combination targeted therapy with vemurafenib and cobimetinib has proved effective for metastatic melanoma. However, severe cutaneous adverse reactions have been reported, most frequently not only drug rash with eosinophilia and systemic syndrome but also rare Stevens-Johnson syndrome and toxic epidermal necrolysis (TEN) cases. We report a case of life-threatening episode of TEN following metastatic melanoma targeted therapy with vemurafenib and cobimetinib, with a long but successful patient recovery.
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Yang, Jiahui, Fangli Wu, Dan Luo, et al. "Toxic epidermal necrolysis syndrome induced by tigecycline: a case report." Journal of International Medical Research 48, no. 5 (2020): 030006052092241. http://dx.doi.org/10.1177/0300060520922416.
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A 56-year-old man diagnosed with non-Hodgkin’s lymphoma underwent autologous bone marrow transplantation. He was subsequently admitted to the hospital with fever, and his symptoms were initially controlled by multiple antibiotics, including tigecycline. He then developed a generalized body rash that improved after treatment with anti-allergy drugs and steroids. Furthermore, tigecycline treatment for a second time resulted in a severe skin reaction with systemic symptoms, suggesting toxic epidermal necrolysis syndrome (TEN). The patient was shown to have the slow-metabolizing cytochrome P450 2C19 allele, denoted CYP2C19*2. He was transferred to a laminar flow ward and given strict mucosal care, together with corticosteroids and intravenous immunoglobulin. He recovered after 3 weeks of treatment. Tigecycline-induced Stevens–Johnson syndrome (SJS)/TEN has rarely been reported in the Chinese population. However, our experience suggests that Asians are more likely to have adverse reactions to drugs metabolized by the cytochrome P450 enzyme. Early identification of drug reactions and immediate cessation of the suspected drug is essential. Additionally, a combined therapy scheme and a clean laminar flow environment may improve the cure rate of SJS/TEN.
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Wong, Anthony, Andrey Augusto Malvestiti, and Mariana de Figueiredo Silva Hafner. "Stevens-Johnson syndrome and toxic epidermal necrolysis: a review." Revista da Associação Médica Brasileira 62, no. 5 (2016): 468–73. http://dx.doi.org/10.1590/1806-9282.62.05.468.
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SUMMARY Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are uncommon, acute and potentially life-threatening adverse cutaneous drug reactions. These pathologies are considered a hypersensitivity reaction and can be triggered by drugs, infections and malignancies. The drugs most often involved are allopurinol, some antibiotics, including sulfonamides, anticonvulsants such as carbamazepine, and some non-steroid anti-inflammatory drugs (NSAIDs). Necrosis of keratinocytes is manifested clinically by epidermal detachment, leading to scalded skin appearance. The rash begins on the trunk with subsequent generalization, usually sparing the palmoplantar areas. Macular lesions become purplish, and epidermal detachment occurs, resulting in flaccid blisters that converge and break, resulting in extensive sloughing of necrotic skin. Nikolsky's sign is positive in perilesional skin. SJS and TEN are considered to be two ends of the spectrum of one disease, differing only by their extent of skin detachment. Management of patients with SJS or TEN requires three measures: removal of the offending drug, particularly drugs known to be high-risk; supportive measures and active interventions. Early diagnosis of the disease, recognition of the causal agent and the immediate withdrawal of the drug are the most important actions, as the course of the disease is often rapid and fatal.
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Chang, C. C., T. M. Lin, C. K. Chang, and H. Lee. "AB1626 ASSOCIATION BETWEEN PRIOR SEVERE CUTANEOUS ADVERSE REACTIONS(SCARS) AND SUBSEQUENT AUTOIMMUNE DISEASE RISK: A NATIONWIDE POPULATION-BASED COHORT STUDY." Annals of the Rheumatic Diseases 82, Suppl 1 (2023): 2047.1–2047. http://dx.doi.org/10.1136/annrheumdis-2023-eular.386.
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BackgroundLife-threatening severe cutaneous adverse reactions (SCARs) include Stevens-Johnson syndrome/toxic epidermal necrolysis, acute generalized exanthematous pustulosis, and drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms. Previous report revealed that a gradual loss of regulatory T (Treg) cell function after resolution of SCARs may increase the risk of subsequently developing autoimmune diseases (ADs). The association between patients with SCARs and ADs remain unclear and are scarce.ObjectivesThis study explored the association of SCARs with AD risk.MethodsIndividuals with SCARs between 2006 and 2015 were identified and 1:10 matched on age and sex with individuals without SCARs. We performed multivariate and stratified analysis using the Kaplan–Meier method and Cox proportional hazards models in order to estimate the association between SCAR cohort and the risk of developing ADs.ResultsA total of 26844 patients with SCAR and 268440 non-SCAR comparison subjects were selected from NHIRD. For individual organ-specific ADs, SCAR cohort as compared with non-SCAR cohort, adjusted hazard ratio (aHR) were higher for incident autoimmune hemolytic anemia (aHR 3.36, 95% CI: 1.84-6.13), Hashimoto’s thyroiditis (aHR 2.26, 95% CI: 1.64-3.12), Henoch-Schonlein purpura (aHR 8.99, 95% CI:6.53-12.4) and inflammatory bowel disease were (aHR 9.78, 95% CI:5.27-18.5) (see Table 1). Furthermore, for individual systemic ADs, SCAR cohort as compared with non-SCAR cohort, aHR were higher for incident ankylosing spondylitis(aHR 1.56), psoriasis(aHR 10.39), polymyositis/dermatomyositis (aHR 10.39), rheumatoid arthritis(aHR 2.48), primary Sjogren syndorme(aHR 5.92), systemic lupus erythematosus(aHR 9.58), systemic sclerosis(aHR 7.56) and systemic vasculitis (aHR 13.54).(see Table 1)ConclusionPatients with SCARs have higher risk of ADs than patients with no SCARs. Further mechanistic research should be conducted.References[1]Guvenir H, Arikoglu T, Vezir E, Misirlioglu ED. Clinical Phenotypes of Severe Cutaneous Drug Hypersensitivity Reactions. Curr Pharm Des. 2019;25(36):3840-3854.[2]Schopf E, Stuhmer A, Rzany B, Victor N, Zentgraf R, Kapp JF. Toxic epidermal necrolysis and Stevens-Johnson syndrome. An epidemiologic study from West Germany. Arch Dermatol 1991; 127:839–42.[3]Rzany B, Mockenhaupt M, Baur S, Schro¨der W, Stocker U, Mueller J, et al. Epidemiology oferythema exsudativum multiforme majus, Stevens-Johnson syndrome, and toxic epidermal.necrolysis in Germany (1990–1992): Structure and results of a population-based registry. J Clin Epidemiol 1996; 49:769–773.[4]Chan HL, Stern RS, Arndt KA, Arndt KA, Langlois J, Jick SS, et al. The incidence of erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis. A population-based study with particular reference to reactions caused by drugs among outpatients. Arch Dermatol 1990; 126:43–7.[5]Chung WH, Wang CW, Dao RL. Severe cutaneous adverse drug reactions. J Dermatol. (2016) 43:758–66.[6]Wolf R, Orion E, Marcos B, Matz H. Life-threatening acute adverse cutaneous drug reactions. Clin Dermatol 2005;23: 171-81.[7]Sunaga Y, Kurosawa M, Ochiai H, Watanabe H, Sueki H, Azukizawa H, et al. The nationwide epidemiological survey of Stevens-Johnson syndrome and toxic epidermal necrolysis in Japan, 2016-2018. J Dermatol Sci. (2020) 100:175–82.[8]Yang MS, Lee JY, Kim J, Kim GW, Kim BK, Kim JY, et al. Searching for the culprit drugs for Stevens-Johnson syndrome and toxic epidermal necrolysis from a nationwide claim database in Korea. J Allergy Clin Immunol Pract. (2020) 8:690–5.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
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Cho, Yung-Tsu, and Chia-Yu Chu. "Treatments for Severe Cutaneous Adverse Reactions." Journal of Immunology Research 2017 (2017): 1–9. http://dx.doi.org/10.1155/2017/1503709.
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Severe cutaneous adverse reaction (SCAR) is life-threatening. It consists of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), acute generalized exanthematous pustulosis (AGEP), and generalized bullous fixed drug eruptions (GBFDE). In the past years, emerging studies have provided better understandings regarding the pathogenesis of these diseases. These diseases have unique presentations and distinct pathomechanisms. Therefore, theoretically, the options of treatments might be different among various SCARs. However, due to the rarity of these diseases, sufficient evidence is still lacking to support the best choice of treatment for patients with SCAR. Herein, we will provide a concise review with an emphasis on the characteristics and treatments of each SCAR. It may serve as a guidance based on the current best of knowledge and may shed light on the directions for further investigations.
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Lucero, Carmen León Rocha, Elizabeth Rodea Montellano Sarahí, del Rosario Escalona Arroyo María, Ramiro García Navarro Ángel, Méndez Carrasco Martha, and Fresnel Narcisse Alvarez Jahir. "Toxic Epidermal Necrolysis Induced by Allopurinol, One Case in a Million." INTERNATIONAL JOURNAL OF MEDICAL SCIENCE AND CLINICAL RESEARCH STUDIES 03, no. 12 (2023): 3123–28. https://doi.org/10.5281/zenodo.10409670.
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<strong>Background</strong>:Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are part of the spectrum of one of the most serious dermatological conditions that occur in the hospital setting, considered a dermatological emergency. Stevens-Johnson syndrome is called toxic epidermal necrolysis (TEN) when ≥30% of the body surface is affected, and it is the most serious form of the disease, with adverse drug reactions being the main etiology, up to 80%. <strong>Clinical case:</strong>We present the clinical case of a 30-year-old male, with a history of systemic arterial hypertension, who began with symptoms after taking allopurinol after being diagnosed with hyperuricemia. It began with a picture of bilateral conjunctivitis, followed by a sudden appearance of localized dermatosis on the face, characterized by erythematous plaques with indistinct, non-painful borders, and later the appearance of ulcers and blisters, extending to 70% of the body surface. During his hospitalization, he developed a lesion acute renal failure, managed by the intensive care service, with total remission upon discharge and favorable response to treatment thanks to multidisciplinary management. Treatment was provided with human immunoglobulin, vancomycin-based antibiotic therapy, and ciprofloxacin for impetiginization of facial ulcers, fluid therapy, Vaseline gauze dressings, and topical ophthalmological treatment, achieving discharge without comorbidities. <strong>Conclusion</strong>:Toxic epidermal necrolysis is a severe picture of Steven Johnson Syndrome, potentially fatal, which requires early multidisciplinary management that leads to the recognition and management of associated comorbidities in a timely manner.Key words: Stevens-Johnson syndrome; toxic epidermal necrolysis; halopurinol, drug reaction.
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Orime, Mari. "Immunohistopathological Findings of Severe Cutaneous Adverse Drug Reactions." Journal of Immunology Research 2017 (2017): 1–5. http://dx.doi.org/10.1155/2017/6928363.
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Diagnosis of severe cutaneous adverse drug reactions should involve immunohistopathological examination, which gives insight into the pathomechanisms of these disorders. The characteristic histological findings of erythema multiforme (EM), Stevens–Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN) provide conclusive evidence demonstrating that SJS/TEN can be distinguished from EM. Established SJS/TEN shows full-thickness, extensive keratinocyte necrosis that develops into subepidermal bullae. Drug-induced hypersensitivity syndrome (DIHS) and exanthema in drug reaction with eosinophilia and systemic symptoms (DRESS) each display a variety of histopathological findings, which may partly correlate with the clinical manifestations. Although the histopathology of DRESS is nonspecific, the association of two or more of the four patterns—eczematous changes, interface dermatitis, acute generalized exanthematous pustulosis- (AGEP-) like patterns, and EM-like patterns—might appear in a single biopsy specimen, suggesting the diagnosis and severe cutaneous manifestations of DRESS. Cutaneous dendritic cells may be involved in the clinical course. AGEP typically shows spongiform superficial epidermal pustules accompanied with edema of the papillary dermis and abundant mixed perivascular infiltrates. Mutations in IL36RN may have a definite effect on pathological similarities between AGEP and generalized pustular psoriasis.
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Amala, Elizabeth Ellickamury, Sona Angel, and Raghavendra K. Dr. "Toxic Epidermal Necrolysis in a Paediatric Patient: A Case Report." International Journal of Science and Healthcare Research 4, no. 1 (2019): 332–36. https://doi.org/10.5281/zenodo.3933005.
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Toxic Epidermal Necrolysis (TEN) and Stevens Johnson’s Syndrome (SJS) are severe adverse cutaneous drug reactions. In addition to severe skin symptoms, it is often accompanied by complications in numerous organs, such as liver, kidney, and lungs. The degree of epidermal detachment less than 10% of body surface area is classified as SJS, greater than 30% as TEN and 10-30% as SJS/TEN overlap. It is thought that this syndrome is a hypersensitivity complex that affects the skin and the mucous membranes.SJS/TEN have been observed with more than 100 drugs. Common culprits are antimicrobials, anti-epileptic drugs and Non-steroidal anti-inflammatory agents (NSAIDs). Diagnosis mainly relies on clinical signs and histopathology of skin lesions. The primary objective for a favourable outcome depends on rapid and aggressive supportive care until the skin regenerates itself in this self- limiting acute skin condition. Here we report an Idiosyncratic drug reaction (IDR) in a 9 year old child.
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Cheng, Chi-Yuan, Shih-Chi Su, Chi-Hua Chen, Wei-Li Chen, Shin-Tarng Deng, and Wen-Hung Chung. "HLA Associations and Clinical Implications in T-Cell Mediated Drug Hypersensitivity Reactions: An Updated Review." Journal of Immunology Research 2014 (2014): 1–8. http://dx.doi.org/10.1155/2014/565320.
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T-cell mediated drug hypersensitivity reactions may range from mild rash to severe fatal reactions. Among them, drug reaction with eosinophilia and systemic symptoms (DRESS) or drug-induced hypersensitivity syndrome (DIHS), Stevens-Johnson syndrome/ toxic epidermal necrolysis (SJS/TEN), are some of the most life-threatening severe cutaneous adverse reactions (SCARs). Recent advances in pharmacogenetic studies show strong genetic associations between human leukocyte antigen (HLA) alleles and susceptibility to drug hypersensitivity. This review summarizes the literature on recent progresses in pharmacogenetic studies and clinical application of pharmacogenetic screening based on associations between SCARs and specific HLA alleles to avoid serious conditions associated with drug hypersensitivity.