A Rare Case Series of Cutaneous Adverse Drug Reaction Presenting with Stevens Johnson Syndrome in A Tertiary Care Rural Hospital of Western Maharashtra (original) (raw)
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Indian Journal of Dermatology, Venereology, and Leprology, 2013
Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare severe cutaneous drug reactions. No large scale epidemiological data are available for this disorder in India. Aims: To carry out a systematic review of the published evidence of the drug-induced SJS and TEN in Indian population. Methods: Publications from 1995 to 2011 describing SJS and TEN in Indian population were searched in PubMed, MEDLINE, EMBASE and UK PUBMED Central electronic databases. Data were collected for the causative drugs and other clinical characteristics of SJS and TEN from the selected studies. Results: From 225 references, 10 references were included as per selection criteria. The major causative drugs were antimicrobials (37.27%), anti-epileptics (35.73%) and non-steroidal anti-inflammatory drugs (15.93%). Carbamazepine (18.25%), phenytoin (13.37%), fluoroquinolones (8.48%) and paracetamol (6.17%) were most commonly implicated drugs. Regional differences were observed for fluoroquinolones, sulfa drugs and carbamazepine. Total 62.96% of patients showed systemic complications. Most common complications were ocular (40.29%) and septicemia (17.65%). Higher mortality was observed for TEN as compared to SJS (odd ratio-7.19; 95% confidence interval (CI) 1.62-31.92; p = 0.0023). Observed mortality is higher than expected as per SCORTEN score 3. Duration of hospital stay was significantly higher in TEN (20.6 days; 95% CI 14.4-26.8) as compared to SJS (9.7 days; 95% CI 5.8-13.6; p = 0.020). Cost of management was significantly higher in TEN (` 7910; 95% CI 5672-10147; p < 0.0001) as compared to SJS (` 2460; 95% CI 1762-3158). No statistical data were described for steroid use in the studies included. Conclusion: Carbamazepine, phenytoin, fluoroquinolones and paracetamol were the major causative drugs. TEN is showing higher mortality, morbidity and economic burden than SJS. How to cite this article: Patel TK, Barvaliya MJ, Sharma D, Tripathi C. A systematic review of the drug-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in Indian population. Indian J Dermatol Venereol Leprol 2013;79:389-98.
Therapeutic Advances in Drug Safety
Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions (SCARs). There is scant literature on the characteristics and causes of these conditions among the Nigerian population. Here, we describe the epidemiology, associated morbidity and mortality, and culpable drugs in SJS and TEN cases using the National Pharmacovigilance (NPC) database in Nigeria. Methods: A retrospective review of the NPC database was done to analyze SJS and TEN cases reported over a period of 14 years. Annual reports, age and sex of patients, type of reporter, suspects and concomitant drugs, time to onset (TTO) of the reactions, and outcome of SJS and TEN were evaluated. Results: The NPC received a total of 24,015 adverse drug reaction (ADR) reports. SJS and TEN accounted for 284 (0.1%) of the total reports, of which 254 (89.4%) were SJS and the remainder were TEN. Females ( n = 184, 64.8%) and individuals aged 19–40 years ( n = 181, 63.7%) were the ...
Background : Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrosis (TEN) are rare but severe adverse drug cutaneous reactions associated with the use of several medications. Objective : To review the current medication use and the risk of stevens-johnson syndrome or toxic epidermal necrosis that is associated with the medicine Studymethod: All publications describing medication use and risk of SJS and TEN in adults and children were searched in Medline and The Cochrane collaboration. The search yielded 920 references, of which 896 were excluded, we couldn't retrieve 11 case reports, hence 13 references were included, which consisted of 4 case-control studies in 1405 cases (5736 controls),a study of 82 retrospectively reviewed cases,7 case reports, a pooled analysis from 2 multicentre case-control studies in paediatric patients involving 80 cases and 216 controls and another study in children consisting of 29 sjs/ten cases. As a result totally 1414 adult cases and 135 paediatric cases of sjs/ten associated with drug use were included in the study.
STEVENS-JOHNSON SYNDROME DUE TO ADVERSE DRUG REACTIONS: A CASE SERIES
Asian Journal of Pharmaceutical and Clinical Research, 2021
Stevens-Johnson syndrome (SJS) is a rare, serious disorder affecting skin and mucous membranes. It is one of the few serious dermatological adverse effects of drugs encountered in clinical practice which is characterized by blisters and rash on skin, mucous membranes, swelling over face and lips, and hyperpigmentation. After that, the outer layer of affected skin becomes dead, sheds, and starts to heal after several days of inflicting injury. Here, we present a case series of ofloxacin and chloroquine induced SJS after the consent given by patients. First case is a 62 years old male received Ofloxacin and second patient is a 40 years old male received chloroquine. Both patients experienced a severe skin reaction which was diagnosed as SJS. The above-mentioned medications will be implicated in cases of SJS. We should prescribe these medications with extreme caution.
Pharmacoepidemiology and Drug Safety, 1996
Spontaneous reporting systems (SRS) have been established to monitor drug safety problems after marketing, especially rare, but serious adverse drug reactions (ADRs). Among these are the skin disorders erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). The purpose of this study has been to evaluate the data on these serious skin disorders available in a SRS. All reports concerning these diseases submitted to the Danish Committee on ADRs during the period 1968 to 1991 were reviewed according to predefined criteria. Information was often scarce, and the diagnosis of the reporter had to be accepted at face value in 28% of cases. Two hundred cases of EM, 74 of SJS and 29 of TEN were identified. More than 60% of cases were hospitalized. The diseases had a fatal outcome in six patients with TEN, three with SJS and a single patient suffering from EM.
Asian Journal of Medical Sciences
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 use...
Stevens-Johnson Syndrome in a Child on Phenytoin, Exacerbated with Cefixime
Journal of Nepal Paediatric Society
Steven Johnson syndrome and toxic epidermal necrolysis are rare but potentially life threatening muco-cutaneous disorders. Their incidence ranges from 1.2 to six per million patient-years for Steven Johnson syndrome and 0.4 to 1.2 per million patient-years for toxic epidermal necrolysis. Drugs are the primary cause for these syndromes in majority cases. They might also be due to infections with Mycoplasma Pneumoniae or Herpes Simplex. The mortality ranges from five to 40% in these cases. We report a 10-year old girl who presented with history of multiple skin eruptions involving whole body and oral ulceration for five days. She was a known case of seizure disorder on phenytoin and had been prescribed Cefexime for fever. She was managed with intravenous fluids, corticosteroids, opiates, antacids and topical antibiotics. We want to highlight the possibility of Steven Johnson syndrome following the combination of these two drugs.
Gaceta medica de Mexico
Stevens-Johnson syndrome and toxic epidermal necrolysis are life-threatening conditions associated with significant morbidity and mortality. They are considered to be part of a spectrum of cutaneous drug reactions, differing only by their extent of skin detachment due to keratinocyte apoptosis. Drugs are assumed as the main cause of Stevens-Johnson syndrome and toxic epidermal necrolysis in most cases. The pathophysiology is incompletely understood; however, current pathogenic models involve Fas ligand, granulysin, and cytokines. Diagnosis relies mainly on clinical signs together with the histological analysis, and treatment requires early cessation of the causative drug and supportive care. Of these conditions, herein we will review the advances in clinical, pathogenesis, and management.
Drug-Induced Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
Revista română de pediatrie, 2016
Steven-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare diseases that appear following the administration of risk drugs. Both are severity grades of the same condition and are considered medical emergencies, because they are potentially lethal. They are characterized by mucocutaneous tenderness, erythema, necrosis and bullous detachment similar to extended burns. We report 3 cases of SJS/TEN in which the etiology was probably drug-related (Paracetamol, Atomoxetinum, Sulfamethoxazolum + trimethoprinum), with restitutio ad integrum following the administration of intravenous immunoglobulins.