1
|
Rajagopal V, Bains A, Kannan K, Bhardwaj A, Elhence P. Uncommon toxic epidermal necrolysis -like presentation of cutaneous lupus erythematosus: A series of 6 cases. Lupus 2024:9612033241255266. [PMID: 38745410 DOI: 10.1177/09612033241255266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
TEN like Lupus erythematosus is an uncommon life-threatening variant of Lupus erythematosus. It is usually associated with flares of systemic lupus erythematosus and also because of widespread skin erosions, it can cause acute skin failure. It is often confused with drug induced TEN, however the management of both the diseases is different and hence correct diagnosis becomes crucial. In this study we aimed to assess the clinical characteristics and outcome of TEN like LE in the Indian population. All patients satisfying ACR/EULAR 2019 criteria for SLE and clinically diagnosed with TEN like LE were retrospectively reviewed. A total of 6 patients were identified. All patients were female. Except 1 patient who presented de-novo, the others had pre-existing symptoms of connective tissue disease. Half of the patients had palmoplantar involvement. Mucosal involvement was only mild. Majority had systemic involvement in the form of nephritis followed by arthralgia, autoimmune hepatitis and autoimmune hemolytic anemia.
Collapse
Affiliation(s)
| | - Anupama Bains
- Department of Dermatology, AIIMS Jodhpur, Jodhpur, India
| | | | | | - Poonam Elhence
- Department of Pathology and Lab Medicine, AIIMS Jodhpur, Jodhpur, India
| |
Collapse
|
2
|
Hung SI, Mockenhaupt M, Blumenthal KG, Abe R, Ueta M, Ingen-Housz-Oro S, Phillips EJ, Chung WH. Severe cutaneous adverse reactions. Nat Rev Dis Primers 2024; 10:30. [PMID: 38664435 DOI: 10.1038/s41572-024-00514-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 06/15/2024]
Abstract
Severe cutaneous adverse reactions (SCARs), which include Stevens-Johnson syndrome and toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (also known as drug-induced hypersensitivity syndrome), acute generalized exanthematous pustulosis, and generalized bullous fixed drug eruption, are life-threatening conditions. The pathogenesis of SCARs involves T cell receptors recognizing drug antigens presented by human leukocyte antigens, triggering the activation of distinct T cell subsets. These cells interact with keratinocytes and various immune cells, orchestrating cutaneous lesions and systemic manifestations. Genetic predisposition, impaired drug metabolism, viral reactivation or infections, and heterologous immunity influence SCAR development and clinical presentation. Specific genetic associations with distinct SCAR phenotypes have been identified, leading to the implementation of genetic screening before prescription in various countries to prevent SCARs. Whilst systemic corticosteroids and conventional immunomodulators have been the primary therapeutic agents, evolving strategies, including biologics and small molecules targeting tumour necrosis factor, different cytokines, or Janus kinase signalling pathways, signify a shift towards a precision management paradigm that considers individual clinical presentations.
Collapse
Affiliation(s)
- Shuen-Iu Hung
- Cancer Vaccine and Immune Cell Therapy Core Laboratory, Department of Medical Research, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- Department and Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Maja Mockenhaupt
- Dokumentationszentrum schwerer Hautreaktionen (dZh), Department of Dermatology, Medical Center and Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Kimberly G Blumenthal
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Riichiro Abe
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Mayumi Ueta
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Saskia Ingen-Housz-Oro
- Dermatology Department, AP-HP, Henri Mondor Hospital, Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Université Paris Est Créteil EpiDermE, Créteil, France
| | - Elizabeth J Phillips
- Center for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wen-Hung Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taipei/Linkou branches, and Chang Gung University, Taoyuan, Taiwan.
- Department of Dermatology, Chang Gung Memorial Hospital, Xiamen branch, Xiamen, China.
| |
Collapse
|
3
|
Fijałkowska A, Kądziela M, Żebrowska A. The Spectrum of Cutaneous Manifestations in Lupus Erythematosus: A Comprehensive Review. J Clin Med 2024; 13:2419. [PMID: 38673692 PMCID: PMC11050979 DOI: 10.3390/jcm13082419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/13/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Lupus erythematosus (LE) is an autoimmune inflammatory disease with complex etiology. LE may present as a systemic disorder affecting multiple organs or be limited solely to the skin. Cutaneous LE (CLE) manifests with a wide range of skin lesions divided into acute, subacute and chronic subtypes. Despite classic forms of CLE, such as malar rash or discoid LE, little-known variants may occur, for instance hypertrophic LE, chilblain LE and lupus panniculitis. There are also numerous non-specific manifestations including vascular abnormalities, alopecia, pigmentation and nail abnormalities or rheumatoid nodules. Particular cutaneous manifestations correlate with disease activity and thus have great diagnostic value. However, diversity of the clinical picture and resemblance to certain entities delay making an accurate diagnosis The aim of this review is to discuss the variety of cutaneous manifestations and indicate the clinical features of particular CLE types which facilitate differential diagnosis with other dermatoses. Although in diagnostically difficult cases histopathological examination plays a key role in the differential diagnosis of LE, quick and accurate diagnosis ensures adequate therapy implementation and high quality of life for patients. Cooperation between physicians of various specialties is therefore crucial in the management of patients with uncommon and photosensitive skin lesions.
Collapse
Affiliation(s)
| | | | - Agnieszka Żebrowska
- Department of Dermatology and Venereology, Medical University of Lodz, Haller sq. 1, 90-647 Lodz, Poland; (A.F.); (M.K.)
| |
Collapse
|
4
|
Gomes Ferreira S, Fernandes L, Santos S, Ferreira S, Sequeira J. Dipyrone (Metamizole)-Induced Stevens-Johnson Syndrome. Cureus 2024; 16:e53122. [PMID: 38420072 PMCID: PMC10899118 DOI: 10.7759/cureus.53122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 03/02/2024] Open
Abstract
Stevens-Johnson Syndrome (SJS), a severe mucocutaneous hypersensitivity reaction primarily triggered by drugs, poses a low-incidence, high-mortality challenge. This report explores its clinical nuances and emphasizes supportive care as the mainstay of treatment. A 74-year-old female, burdened with a complex medical history, presented with a non-pruritic macular rash escalating to skin and oral mucosal involvement. A recent introduction of dipyrone (metamizole) implicated drug-induced SJS. Histopathological confirmation guided treatment involving supportive care, corticosteroids, and wound care, resulting in clinical improvement. The case underscores the significance of histopathological confirmation and thorough medication history in navigating SJS complexities, especially in patients with comorbidities like connective tissue disease. A successful multidisciplinary approach and the decision for post-discharge monitoring highlight the intricate management challenges. This case illuminates the intricate interplay of medication-induced hypersensitivity, comorbidities, and management challenges in SJS. Optimal outcomes require prompt diagnosis, trigger identification, and a multidisciplinary treatment approach, emphasizing ongoing research and clinical vigilance.
Collapse
Affiliation(s)
- Sérgio Gomes Ferreira
- Internal Medicine, Hospital São Sebastião, Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, PRT
| | - Luís Fernandes
- Internal Medicine, Hospital São Sebastião, Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, PRT
| | - Sara Santos
- Internal Medicine, Hospital São Sebastião, Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, PRT
| | - Sofia Ferreira
- Internal Medicine, Hospital São Sebastião, Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, PRT
| | - Joana Sequeira
- Internal Medicine, Hospital São Sebastião, Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, PRT
| |
Collapse
|
5
|
Wasuwanich P, So JM, Chakrala TS, Chen J, Motaparthi K. Epidemiology of Stevens-Johnson syndrome and toxic epidermal necrolysis in the United States and factors predictive of outcome. JAAD Int 2023; 13:17-25. [PMID: 37575514 PMCID: PMC10413346 DOI: 10.1016/j.jdin.2023.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 08/15/2023] Open
Abstract
Background Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS-TEN overlap syndrome are rare severe cutaneous adverse reactions associated with high mortality. Objectives To estimate incidence and describe trends of SJS/TEN hospitalizations in the United States and to describe the clinical, demographic, and geographic characteristics of affected patients and risk factors for mortality. Methods We utilized hospitalization data from the 2010 to 2020 National Inpatient Sample. SJS, SJS-TEN overlap syndrome, and TEN were identified by International Classification of Diseases, 9th Revision and International Classification of Diseases, 10th Revision codes and analyzed by logistic regression. Results We identified 51,040 hospitalizations involving SJS/TEN. Amog those, 37,283 (73.0%) were for SJS only, 7818 (15.3%) were for SJS-TEN overlap syndrome, and 7160 (14.0%) were for TEN only. Overall, SJS/TEN hospitalization rates declined over time, 2010 to 2020 (P < .05). Mortality rates of the SJS group, SJS-TEN overlap syndrome group, and TEN group were 5.4%, 14.4%, and 15.3%, respectively. Increasing age, chronic kidney disease, pneumonia, sepsis, and malignant neoplasm were all significantly associated with increased odds of mortality (P < .05). Non-Hispanic White racial/ethnic identification was associated with decreased odds of mortality (P < .05). Limitations Lack of standardization for diagnostic criteria. Conclusions Risk factors identified in this study lay the groundwork for improvement in SJS/TEN mortality prediction scoring.
Collapse
Affiliation(s)
- Paul Wasuwanich
- University of Florida College of Medicine, Gainesville, Florida
| | - Joshua M. So
- University of Florida College of Medicine, Gainesville, Florida
| | - Teja S. Chakrala
- Department of Internal Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Jinghua Chen
- Department of Ophthalmology, University of Florida College of Medicine, Gainesville, Florida
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
| |
Collapse
|
6
|
Saito Y, Abe R. New insights into the diagnosis and management of Stevens-Johnson syndrome and toxic epidermal necrolysis. Curr Opin Allergy Clin Immunol 2023; 23:271-278. [PMID: 37284785 DOI: 10.1097/aci.0000000000000914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE OF REVIEW Recent studies have been clarifying the pathogenesis and early diagnostic markers of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Additionally, the efficacy of tumor necrosis factor alpha inhibitors is attracting attention. This review provides) recent evidence for the diagnosis and management of SJS/TEN. RECENT FINDINGS Risk factors for the development of SJS/TEN have been identified, particularly the association between HLA and the onset of SJS/TEN with specific drugs, which has been intensively studied. Research on the pathogenesis of keratinocyte cell death in SJS/TEN has also progressed, revealing the involvement of necroptosis, an inflammatory cell death, in addition to apoptosis. Diagnostic biomarkers associated with these studies have also been identified. SUMMARY The pathogenesis of SJS/TEN remains unclear and effective therapeutic agents have not yet been established. As the involvement of innate immunity, such as monocytes and neutrophils, in addition to T cells, has become clear, a more complex pathogenesis is predicted. Further elucidation of the pathogenesis of SJS/TEN is expected to lead to the development of new diagnostic and therapeutic agents.
Collapse
Affiliation(s)
- Yuki Saito
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | | |
Collapse
|
7
|
Coulson CJ, Yrastorza-Daghman M. Aripiprazole-Induced Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: A Case Study. Clin Neuropharmacol 2023; Publish Ahead of Print:00002826-990000000-00055. [PMID: 37335846 DOI: 10.1097/wnf.0000000000000560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
OBJECTIVES The use of medications in management of disease is an integral part of treatment to patients in both the inpatient and outpatient setting; however, these medications often have risk of adverse effects associated with their benefits of use. Adverse cutaneous reactions are one of the most frequent types of adverse drug reactions. Two major phenotypes of cutaneous adverse drug reactions are toxic epidermal necrolysis (TEN), and Stevens-Johnson syndrome (SJS). Aripiprazole is an antipsychotic drug with a well-documented profile of adverse effects for physicians to be aware of; however, SJS/TEN is not known to be included in that profile. METHODS The authors encountered a case of aripiprazole-induced SJS/TEN and used the electronic medical records from this encounter to summarize this novel case in detail. Existing literature was reviewed using public databases for evaluation of similar cases. RESULTS We present a case of SJS/TEN induced by aripiprazole use for bipolar disorder, type 1, which is not an adverse effect of the drug that has been documented in the literature. We include patient history, hospital course, images, and treatment of disease throughout admission as well as a thorough discussion of the topic. CONCLUSIONS We present a case of an adverse drug reaction that has not previously been documented in the literature with the goal of informing readers of the potential for this life-threatening atypical effect and the severity of disease it may cause.
Collapse
|
8
|
Morgado-Carrasco D, Mascaró Jr J. [Translated article] Indirect Immunofluorescence Findings in a Patient With Toxic Epidermal Necrolysis–Like Cutaneous Lupus Erythematosus. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:T905-T906. [DOI: 10.1016/j.ad.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/11/2021] [Indexed: 10/16/2022] Open
|
9
|
Abstract
Systemic autoimmune diseases are reportedly associated with a high frequency of drug allergies. In particular, systemic lupus erythematosus (SLE), Sjögren's syndrome (SS), and adult-onset Still's disease (AOSD) have recently drawn attention. Based on previous reports, drug allergies have been reported in 17.1-63%, 7-40.1%, and 17.6-54% of patients with SS, SLE, and AOSD patients, respectively. Antimicrobial agents, including sulfa drugs and nonsteroidal anti-inflammatory drugs, are the most common causative agents of drug allergies. However, few studies have examined in detail the relationship between drug eruptions, a major symptom of drug allergy, and systemic autoimmune diseases, and their actual status remains unclear. These autoimmune diseases commonly exhibit a diverse range of skin manifestations in the course of these diseases, rendering it may be difficult to determine whether it is a true drug eruption. Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), a fatal, severe drug eruption, has also been associated with autoimmune diseases. The development of SS-like symptoms after SJS/TEN onset and high prevalence of anti-SS-A antibodies in SJS/TEN are intriguing observations. Although the presence of SLE is known to be a risk factor for SJS/TEN, common pathological conditions, such as excessive immune status, abnormal function of regulatory T cells, and neutrophil extracellular traps in autoimmune diseases such as SS and SLE, are potentially involved in the development of drug eruptions.
Collapse
Affiliation(s)
- Yuko Watanabe
- Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
| | - Yukie Yamaguchi
- Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| |
Collapse
|
10
|
Truong K, Goldinger S, Kim J, Smith A, Fernandez-Peñas P. Toxic epidermal necrolysis-like lupus erythematosus: a condition to exclude in all patients with possible Stevens-Johnson syndrome/toxic epidermal necrolysis. J Eur Acad Dermatol Venereol 2021; 36:e218-e221. [PMID: 34661931 DOI: 10.1111/jdv.17753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 09/18/2021] [Accepted: 10/15/2021] [Indexed: 11/27/2022]
Affiliation(s)
- K Truong
- Department of Dermatology, Westmead Hospital, Westmead, NSW, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - S Goldinger
- Department of Dermatology, Westmead Hospital, Westmead, NSW, Australia
| | - J Kim
- Department of Tissue Pathology and Diagnostic Oncology, Institute of Clinical Pathology and Medical Research, ICPMR) Westmead Hospital, Westmead, NSW, Australia
| | - A Smith
- Department of Dermatology, Westmead Hospital, Westmead, NSW, Australia
| | - P Fernandez-Peñas
- Department of Dermatology, Westmead Hospital, Westmead, NSW, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
11
|
Gaudin O, Milpied B, Papouin B, Hüe S, Ortonne N, Régnier E, Wolkenstein P, Chosidow O, de Prost N, Ingen-Housz-Oro S. Lupus erythematosus and epidermal necrolysis: a case series of 16 patients. Br J Dermatol 2021; 186:372-374. [PMID: 34597413 DOI: 10.1111/bjd.20775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/24/2021] [Accepted: 09/26/2021] [Indexed: 01/18/2023]
Affiliation(s)
- O Gaudin
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France
| | - B Milpied
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France.,Dermatology Department, Saint André Hospital, Bordeaux, France
| | - B Papouin
- Pathology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - S Hüe
- Université Paris-Est Créteil Val de Marne, UPEC, Créteil, France.,INSERM U955, Université Paris Est Créteil Val de Marne, UPEC, Créteil, France.,Immunology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - N Ortonne
- Pathology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Université Paris-Est Créteil Val de Marne, UPEC, Créteil, France
| | - E Régnier
- Dermatology Department, AP-HP, Cochin Hospital, Paris, France
| | - P Wolkenstein
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France.,Université Paris-Est Créteil Val de Marne, UPEC, Créteil, France
| | - O Chosidow
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France.,Université Paris-Est Créteil Val de Marne, UPEC, Créteil, France.,Groupe de Recherche Dynamyc, EA7380, Faculté de Santé de Créteil, École Nationale Vétérinaire d'Alfort, USC ANSES, Université Paris-Est Créteil, Créteil, France
| | - N de Prost
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France.,Université Paris-Est Créteil Val de Marne, UPEC, Créteil, France.,Intensive Care Unit, AP-HP, Henri Mondor Hospital, Créteil, France
| | - S Ingen-Housz-Oro
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France.,EpiDermE, Université Paris-Est Créteil, Créteil, France
| |
Collapse
|
12
|
Marti-Marti I, Morgado-Carrasco D, Carrera C, Alamon-Reig F, Serra-García L, Mascaró JM. Stevens-Johnson syndrome/toxic epidermal necrolysis-like cutaneous lupus erythematosus. A case series with long-term follow-up. J Eur Acad Dermatol Venereol 2021; 36:e135-e139. [PMID: 34551165 DOI: 10.1111/jdv.17698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- I Marti-Marti
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - D Morgado-Carrasco
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - C Carrera
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - F Alamon-Reig
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - L Serra-García
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - J M Mascaró
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
13
|
Fukasawa T, Takahashi H, Takahashi K, Tanemura N, Amagai M, Urushihara H. Risk of Stevens-Johnson syndrome and toxic epidermal necrolysis associated with anticonvulsants in a Japanese population: Matched case-control and cohort studies. Allergol Int 2021; 70:335-342. [PMID: 33618992 DOI: 10.1016/j.alit.2021.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Evidence for the risk and incidence of anticonvulsant-induced Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in Japan is scarce. METHODS We conducted a matched case-control study using a large-scale Japanese claims database. SJS/TEN cases were identified using a claims-based algorithm developed in a previous study (sensitivity 76.9%, specificity 99.0%). Conditional logistic regression with Firth's bias correction to address an issue of rare events was used to estimate odds ratios (ORs) for SJS/TEN for each anticonvulsant use (90 days before the index date) versus non-use. 90-day cumulative incidence of SJS/TEN per 100,000 new users was calculated for 33 anticonvulsants. Causality between anticonvulsant use and SJS/TEN in each exposed case was assessed using the algorithm of drug causality for epidermal necrolysis (ALDEN) score. RESULTS From 5,114,492 subjects, we selected 71 SJS/TEN cases and 284 controls. We observed significantly increased ORs for SJS/TEN among new users of carbamazepine (OR 68.00) and lamotrigine (OR 36.00) with ALDEN scores of "probable" or higher. Cumulative incidence of SJS/TEN was 93.83 for carbamazepine and 84.33 for lamotrigine. One case newly exposed to phenytoin which developed SJS/TEN was rated "unlikely" in ALDEN causality, resulting in cumulative incidence of 66.27. Cumulative incidence of SJS/TEN was 25.23 for levetiracetam, 7.52 for clonazepam, and 1.23 for diazepam, but their ALDEN scores were "very unlikely". CONCLUSIONS This study is the first to document the differential risk of SJS/TEN for anticonvulsants in a real-world setting in Japan. Exposure to carbamazepine and lamotrigine was associated with an increased risk of SJS/TEN.
Collapse
|
14
|
Morgado-Carrasco D, Mascaró Jr J. Hallazgos de inmunofluorescencia indirecta en una paciente con lupus eritematoso cutáneo de tipo necrólisis epidérmica tóxica. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.ad.2021.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
15
|
Bitar C, Menge TD, Chan MP. Cutaneous manifestations of lupus erythematosus: A practical clinicopathologic review for pathologists. Histopathology 2021; 80:233-250. [PMID: 34197657 DOI: 10.1111/his.14440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 11/27/2022]
Abstract
Accurate diagnosis of connective tissue diseases is often challenging and relies on careful correlation between clinical and histopathologic features, direct immunofluorescence studies, and laboratory workup. Lupus erythematosus (LE) is a prototype of connective tissue disease with a variety of cutaneous and systemic manifestations. Microscopically, cutaneous LE is classically characterized by an interface dermatitis, although other histopathologic patterns also exist depending on the clinical presentation, location, and chronicity of the skin lesions. In this article, we review the clinical, serologic, histopathologic, and direct immunofluorescence findings in LE-specific and LE-nonspecific skin lesions, with an emphasis on lesser known variants, newly described features, and helpful ancillary studies. This review will guide general pathologists and dermatopathologists in accurately diagnosing and subclassifying cutaneous LE.
Collapse
Affiliation(s)
- Carole Bitar
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Tyler D Menge
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - May P Chan
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
16
|
Cooper EE, Pisano CE, Shapiro SC. Cutaneous Manifestations of "Lupus": Systemic Lupus Erythematosus and Beyond. Int J Rheumatol 2021; 2021:6610509. [PMID: 34113383 PMCID: PMC8154312 DOI: 10.1155/2021/6610509] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 05/11/2021] [Indexed: 11/18/2022] Open
Abstract
Lupus, Latin for "wolf," is a term used to describe many dermatologic conditions, some of which are related to underlying systemic lupus erythematosus, while others are distinct disease processes. Cutaneous lupus erythematosus includes a wide array of visible skin manifestations and can progress to systemic lupus erythematosus in some cases. Cutaneous lupus can be subdivided into three main categories: acute cutaneous lupus erythematosus, subacute cutaneous lupus erythematosus, and chronic cutaneous lupus erythematosus. Physical exam, laboratory studies, and histopathology enable differentiation of cutaneous lupus subtypes. This differentiation is paramount as the subtype of cutaneous lupus informs upon treatment, disease monitoring, and prognostication. This review outlines the different cutaneous manifestations of lupus erythematosus and provides an update on both topical and systemic treatment options for these patients. Other conditions that utilize the term "lupus" but are not cutaneous lupus erythematosus are also discussed.
Collapse
Affiliation(s)
- Elizabeth E. Cooper
- Department of Dermatology, Dell Medical School at the University of Texas, Austin 78701, USA
| | - Catherine E. Pisano
- Department of Dermatology, Dell Medical School at the University of Texas, Austin 78701, USA
| | - Samantha C. Shapiro
- Department of Medicine, Division of Rheumatology, Dell Medical School at the University of Texas, Austin 78701, USA
| |
Collapse
|
17
|
Case RA, Patel V, Mejia-Otero C, Siroy AE, Patel DC. Anti-MDA-5 Dermatomyositis With Development of Drug-Mediated Necrolytic Skin Lesions. J Investig Med High Impact Case Rep 2021; 8:2324709620940496. [PMID: 32643953 PMCID: PMC7350393 DOI: 10.1177/2324709620940496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 59-year-old male presented with 1 month of progressive dyspnea, 30-lb weight loss, and skin changes on the digits of the hands. In the 4 weeks prior to admission, he was admitted and treated twice for pneumonia at another hospital and received intravenous (IV) vancomycin, ceftriaxone, and azithromycin for a total of 10 days. After admission, he underwent computed tomography imaging of chest, which revealed findings suggestive of interstitial lung disease but given the fact that infection was not ruled out, empiric antibiotics were initiated. The skin lesions on the fingers were felt to be consistent with Gottron’s papules, and his overall constellation of findings were felt to be consistent with dermatomyositis (DM). Over the following 3 days, he developed diffuse, violaceous skin lesions, elevation of liver transaminases, and severe thrombocytopenia. The skin lesions progressed to epidermal necrosis. He developed erosions of the oral mucosa and scrotum. Before skin biopsy results were finalized, IV immunoglobulin and IV dexamethasone were started empirically for suspected DM and immune-mediated thrombocytopenia. His laboratory abnormalities normalized within a week. Biopsy results of the skin were consistent with Stevens-Johnson syndrome (SJS). Autoantibody test for anti-MDA5 were positive, confirming a diagnosis of anti-MDA5 associated DM. Subsequent development of SJS was likely due to antibiotic exposure in the preceding month. Simultaneous development of anti-MDA5 DM and SJS raises the question of a link between the 2 conditions. To our knowledge, this is the first reported association of these 2 conditions reported in the literature.
Collapse
|
18
|
Cheng L. Current Pharmacogenetic Perspective on Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Front Pharmacol 2021; 12:588063. [PMID: 33981213 PMCID: PMC8107822 DOI: 10.3389/fphar.2021.588063] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/22/2021] [Indexed: 12/19/2022] Open
Abstract
Adverse drug reactions are a public health issue that draws widespread attention, especially for Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) which have high mortality and lack of efficacious treatment. Though T-cell-mediated HLA-interacted immune response has been extensively studied, our understanding of the mechanism is far from satisfactory. This review summarizes infection (virus, bacterial, and mycoplasma infection), an environmental risk factor, as a trigger for SJS/TEN. The mutations or polymorphisms of drug metabolic enzymes, transporters, receptors, the immune system genes, and T-cell-mediated apoptosis signaling pathways that contribute to SJS/TEN are discussed and summarized. Epigenetics, metabolites, and mobilization of regulatory T cells and tolerogenic myeloid precursors are emerged directions to study SJS/TEN. Ex vivo lymphocyte transformation test has been exploited to aid in identifying the causative drugs. Critical questions on the pathogenesis of SJS/TEN underlying gene polymorphisms and T cell cytotoxicity remain: why some of the patients carrying the risky genes tolerate the drug and do not develop SJS/TEN? What makes the skin and mucous membrane so special to be targeted? Do they relate to skin/mucous expression of transporters? What is the common machinery underlying different HLA-B alleles associated with SJS/TEN and common metabolites?
Collapse
Affiliation(s)
- Lin Cheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
19
|
Neerukonda VK, Stagner AM. Stevens Johnson syndrome: A review of a vision and life-threatening mucocutaneous disease including histopathology with updates on pathogenesis and genetic risk factors. Semin Ophthalmol 2021; 36:270-281. [PMID: 33764253 DOI: 10.1080/08820538.2021.1893764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) spectrum of diseases are devastating blistering disorders involving mucosal surfaces with ocular sequelae that manifest particularly profound long-term morbidity. Advances in deoxyribonucleic acid (DNA) sequencing, genome-wide association studies, and both molecular and pharmacogenetics have helped clarify genetic susceptibility and characterize the iatrogenic risk of SJS for a given patient. METHODS A review of peer reviewed publications featured on PubMed pertaining to the clinical, pathologic, pharmacogenetic and molecular genetic features of SJS/TEN was conducted. Propose: To provide an in-depth clinicopathologic description of the ocular, ocular adnexal, and cutaneous findings in SJS/TEN, summarize pathogenesis and related conditions, and provide an update on the molecular genetic modifications that contribute to the phenotypic variations and genetic susceptibilities of SJS. CONCLUSIONS HLA subtyping and other genetic testing may eventually be valuable in the appropriate context to prevent the debilitating ocular sequelae of SJS, particularly as it relates to medication use.
Collapse
|
20
|
Roberts EJ, Melchionda V, Saldanha G, Shaffu S, Royle J, Harman KE. Toxic epidermal necrolysis-like lupus. Clin Exp Dermatol 2021; 46:1299-1303. [PMID: 33760256 DOI: 10.1111/ced.14648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/02/2021] [Accepted: 03/22/2021] [Indexed: 11/28/2022]
Abstract
Toxic epidermal necrosis (TEN)-like lupus is a rare condition characterized by epidermal loss and mucosal ulceration occurring in patients with acute severe flares of systemic lupus erythematosus. The clinical picture may mimic drug-induced Stevens-Johnson syndrome/TEN; however, the absence of a suitable culprit drug, and the context of acute lupus point to the correct diagnosis. In a case series of three patients, further discriminating features included a slower onset of epidermal loss, more limited mucosal ulceration and a lack of ocular involvement when compared with drug-induced TEN. Histology may show similar features, including basal layer vacuolation, apoptosis and full-thickness epidermal necrosis. Patients with TEN-like lupus may have additional features of lupus, and a lupus band on direct immunofluorescence. It is important to identify this condition correctly, so that these patients can be appropriately managed with early input from Rheumatologists and prompt treatment with high-dose combined immunosuppressant therapy.
Collapse
Affiliation(s)
- E J Roberts
- Dermatology Department, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
| | - V Melchionda
- Dermatology Department, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
| | - G Saldanha
- Histopathology Department, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
| | - S Shaffu
- Rheumatology Department, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
| | - J Royle
- Rheumatology Department, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
| | - K E Harman
- Dermatology Department, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
| |
Collapse
|
21
|
Noe MH, Micheletti RG. Diagnosis and management of Stevens-Johnson syndrome/toxic epidermal necrolysis. Clin Dermatol 2020; 38:607-612. [DOI: 10.1016/j.clindermatol.2020.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
22
|
Williams V, Reddy M, Bansal A, Baranwal AK, Nallasamy K, Angurana SK, Handa S, Ram J, Jayashree M, Singhi S. Intensive care needs and long-term outcome of pediatric toxic epidermal necrolysis - A 10-year experience. Int J Dermatol 2020; 60:44-52. [PMID: 32686136 DOI: 10.1111/ijd.15054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 05/28/2020] [Accepted: 06/17/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Toxic epidermal necrolysis (TEN) is a life-threatening severe cutaneous adverse reaction. Data on pediatric TEN is limited. METHODS Case records of 44 children, 1 month-12 years with a diagnosis of TEN (>30% body surface area [%BSA] detachment) admitted to a tertiary pediatric intensive care unit (PICU) between 2009 and 2018 were analyzed retrospectively. The primary outcome was mortality, and secondary outcomes were organ dysfunction, length of stay (LOS), and long-term sequelae. RESULTS Median (IQR) age was 6.5 (3.6, 8.0) years, and 25 (57%) were boys. Median (IQR) %BSA involved, SCORTEN score, and PRISM-III were 65% (45, 80); 2 (2, 3) and 13 (10, 16), respectively. Antiepileptics (n = 24, 54.6%) and antimicrobials (n = 8, 18.2%) were the most common offending agents. Twenty-four (54.5%) children had culture positive sepsis. Immunomodulatory therapy was provided in 35 (79.5%) and conservative management in nine (20.5%) children. Intravenous immunoglobulin (IVIG) was given in 22 (50%), steroids in three (6.8%), and both IVIG and steroids in 10 (22.7%) children. Respiratory failure (n = 14, 31.8%) was the commonest organ failure. Mortality was 15.9% (n = 7), and median (IQR) PICU-LOS in survivors was 8 (4, 11.75) days. There was no association between IVIG, steroids, or conservative management with mortality or LOS. Ocular sequelae (n = 20, 54.1%) were the most common long-term complication followed by skin (18, 40.1%). CONCLUSION Immunomodulation with IVIG or steroids was not associated with any mortality benefit as compared to conservative management alone. Further research is required to determine the most effective treatment in pediatric TEN.
Collapse
Affiliation(s)
- Vijai Williams
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mounika Reddy
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arun Bansal
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arun K Baranwal
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Karthi Nallasamy
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Suresh K Angurana
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sanjeev Handa
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Jagat Ram
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Muralidharan Jayashree
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sunit Singhi
- Pediatrics, Medanta, The Medicity, Gurugram, NCR, India
| |
Collapse
|
23
|
Toxic Epidermal Necrolysis-like Subacute Cutaneous Lupus Erythematosus: a Case Report. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2020. [DOI: 10.2478/sjdv-2019-0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Cutaneous lupus erythematosus (LE) encompasses a wide spectrum of dermatologic manifestations, including toxic epidermal necrolysis (TEN)-like presentations of acute or subacute cutaneous lupus erythematosus (TEN-like ACLE/SCLE). Although the clinical characteristics and histological features of these rare entities may closely mimic TEN, several subtle differences can help in differentiation between these conditions. We report a case of a patient with SCLE which developed drug unrelated TEN-like blisters after prolonged, intensive sun exposure and focus on a discussion of distinctive features that can be used to differentiate drug-induced TEN and TEN-like presentation of ACLE/SCLE.
Collapse
|
24
|
Santiago L, Mascarenhas R, Tellechea Ó, Gonçalo M. Toxic epidermal necrolysis-like subacute cutaneous lupus erythematosus associated with lung carcinoma. BMJ Case Rep 2019; 12:12/10/e231152. [DOI: 10.1136/bcr-2019-231152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Specific vesiculobullous skin lesions in lupus erythematosus (LE) are rare and must be differentiated from toxic epidermal necrolysis (TEN), TEN-like dermatoses and other vesiculobullous conditions. We report a patient with typical subacute cutaneous lupus erythematous that progressed with large sheet-like areas of epidermal detachment and Nikolsky sign resembling TEN. She had a serological profile suggestive of underlying connective tissue disease, histological findings of interface dermatitis with a lymphocytic infiltrate, positive direct immunofluorescence, resolution with immunomodulation and lack of a culprit drug, features observed in TEN-like cutaneous lupus erythematous. Furthermore, she was diagnosed with lung carcinoma, an association that has been previously reported. Differentiating a bullous eruption in the context of pre-existing LE remains difficult requiring a thorough analysis of clinical and histopathological data.
Collapse
|
25
|
Rutnin S, Chanprapaph K. Vesiculobullous diseases in relation to lupus erythematosus. Clin Cosmet Investig Dermatol 2019; 12:653-667. [PMID: 31564947 PMCID: PMC6732903 DOI: 10.2147/ccid.s220906] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/13/2019] [Indexed: 12/13/2022]
Abstract
Vesiculobullous lesions in lupus erythematosus (LE) are a rare cutaneous manifestation of cutaneous and/or systemic LE with variable presentation. While the minor forms of LE-associated vesiculobullous disease may cause disfigurement and discomfort, the severe forms can present with hyperacute reaction and life-threatening consequences. Specific LE and aspecific cutaneous LE are defined by the presence or absence of interface change on histopathology that can be applied to vesiculobullous diseases in relation to LE. However, the diagnosis of LE-associated vesiculobullous diseases remains difficult, due to the poorly defined nosology and the similarities in clinical and immunohistopathological features among them. Herein, we thoroughly review the topic of vesiculobullous skin disorders that can be encountered in LE patients and organize them into four groups: LE-specific and aspecific vesiculobullous diseases, LE-related autoimmune bullous diseases, and LE in association to non-autoimmune conditions. We sought to provide an updated overview highlighting the pathogenesis, clinical, histological, and immunopathological features, laboratory findings, and treatments and prognosis among vesiculobullous conditions in LE.
Collapse
Affiliation(s)
- Suthinee Rutnin
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kumutnart Chanprapaph
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
26
|
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis–Like Lupus Erythematosus. ACTA ACUST UNITED AC 2019; 25:224-231. [DOI: 10.1097/rhu.0000000000000830] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
27
|
Aiempanakit K, Chiratikarnwong K, Juthong S, Auepemkiate S. Toxic epidermal necrolysis-like acute cutaneous lupus erythematosus in a patient with progressive systemic sclerosis. Lupus 2018; 27:1860-1863. [PMID: 30028256 DOI: 10.1177/0961203318789766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 60-year-old female was diagnosed with progressive systemic sclerosis and interstitial lung disease of two months' duration. The patient was treated for Raynaud phenomenon with aspirin, nifedipine, colchicine, and naproxen. Two weeks after treatment, she developed widespread erythematous patches with blistering eruptions on the face, torso, and extremities, and also had erosion on the oral mucosa. Skin biopsy for histopathology and direct immunofluorescent studies were suggestive of lupus erythematosus. To the best of our knowledge, this is the first case of toxic epidermal necrolysis-like acute cutaneous lupus erythematosus in a patient with progressive systemic sclerosis.
Collapse
Affiliation(s)
- K Aiempanakit
- 1 Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - K Chiratikarnwong
- 1 Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - S Juthong
- 2 Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - S Auepemkiate
- 3 Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| |
Collapse
|
28
|
Liu RF, Chung WH, Yang CY, Wang FY, Chen CB. Neonatal lupus erythematosus presenting as Stevens-Johnson syndrome. DERMATOL SIN 2018. [DOI: 10.1016/j.dsi.2017.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
29
|
Dumas M, Hua C, Hotz C, Velter C, Duong TA, Maraffi T, Ortonne N, Hüe S, Fardet L, de Prost N, Wolkenstein P, Ingen-Housz-Oro S, Chosidow O. Epidermal necrolysis and autoimmune diseases: two more observations supporting the concept that 'toxic' epidermal necrolysis can be 'non-toxic'. J Eur Acad Dermatol Venereol 2018. [PMID: 29524279 DOI: 10.1111/jdv.14935] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- M Dumas
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - C Hua
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - C Hotz
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - C Velter
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - T A Duong
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - T Maraffi
- Intensive Care Unit, AP-HP, Henri Mondor Hospital, Créteil, France
| | - N Ortonne
- Pathology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Université Paris Est Créteil Val de marne, UPEC, Créteil, France
| | - S Hüe
- Université Paris Est Créteil Val de marne, UPEC, Créteil, France.,Immunology Department, AP-HP, Henri Mondor hospital, Créteil, France
| | - L Fardet
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - N de Prost
- Intensive Care Unit, AP-HP, Henri Mondor Hospital, Créteil, France
| | - P Wolkenstein
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Université Paris Est Créteil Val de marne, UPEC, Créteil, France.,Referral Center for Severe Cutaneous Adverse Reactions, Créteil, France
| | - S Ingen-Housz-Oro
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Referral Center for Severe Cutaneous Adverse Reactions, Créteil, France
| | - O Chosidow
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Université Paris Est Créteil Val de marne, UPEC, Créteil, France.,Referral Center for Severe Cutaneous Adverse Reactions, Créteil, France
| |
Collapse
|
30
|
Abstract
During the past decade, major advances have been made in the accurate diagnosis of severe cutaneous adverse reactions (SCARs) to drugs, management of their manifestations, and identification of their pathogenetic mechanisms and at-risk populations. Early recognition and diagnosis of SCARs are key in the identification of culprit drugs. SCARS are potentially life threatening, and associated with various clinical patterns and morbidity during the acute stage of Stevens-Johnson syndrome and toxic epidermal necrolysis, drug reactions with eosinophilia and systemic symptoms, and acute generalised exanthematous pustulosis. Early drug withdrawal is mandatory in all SCARs. Physicians' knowledge is essential to the improvement of diagnosis and management, and in the limitation and prevention of long-term sequelae. This Seminar provides the tools to help physicians in their clinical approach and investigations of SCARs.
Collapse
Affiliation(s)
- Tu Anh Duong
- Department of Dermatology, Hôpital Henri-Mondor, AP-HP, Créteil, France; Centre de Référence des Dermatoses Bulleuses Toxiques, Créteil, France.
| | - Laurence Valeyrie-Allanore
- Department of Dermatology, Hôpital Henri-Mondor, AP-HP, Créteil, France; Centre de Référence des Dermatoses Bulleuses Toxiques, Créteil, France
| | - Pierre Wolkenstein
- Department of Dermatology, Hôpital Henri-Mondor, AP-HP, Créteil, France; Centre de Référence des Dermatoses Bulleuses Toxiques, Créteil, France; EA 7379 EpiDermE (Epidémiologie en Dermatologie et Evaluation des Thérapeutiques), Université Paris-Est Créteil Val-de-Marne, Créteil, France
| | - Olivier Chosidow
- Department of Dermatology, Hôpital Henri-Mondor, AP-HP, Créteil, France; Centre de Référence des Dermatoses Bulleuses Toxiques, Créteil, France; EA 7379 EpiDermE (Epidémiologie en Dermatologie et Evaluation des Thérapeutiques), Université Paris-Est Créteil Val-de-Marne, Créteil, France; French Satellite of the Cochrane Skin Group, Créteil, France; INSERM, Centre d'Investigation Clinique 1430, Créteil, France
| |
Collapse
|
31
|
Registries as useful tools in characterization of allergic manifestations. Curr Opin Allergy Clin Immunol 2017; 16:250-6. [PMID: 27031675 DOI: 10.1097/aci.0000000000000265] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Registries are useful to discover the applicability of data generated from randomized clinical trials (RCTs) into daily practice, and to search for real-life data usually not covered by them. RECENT FINDINGS In allergy, registry research brought clues to important epidemiological and clinical problems hardly accessible with other methods. The increase in the asthma prevalence in Sweden in contrast with stabilization in Denmark; the association of the prevalence of asthma and environmental factors; the knowledge of existing rhinitis international guidelines, but the poorly complacence of some of their recommendations; the low epinephrine use in anaphylaxis and the difference among European and Latin American elicitors; the predominance of β lactams or NSAIDs as drug hypersensitivity reactions inducers in different regions; the fact that most of the hereditary angioedema patients were receiving long-term prophylaxis with attenuated androgens; all the mentioned are clear examples of relevant and important data provided by current registries. SUMMARY Registries in allergy enlighten knowledge in areas not covered by classical investigational methods. As the number and importance of registries is growing, its contribution to the knowledge and management of allergic diseases will increase in the near future.
Collapse
|
32
|
Argobi Y, Smith GP. Cutaneous Manifestations of Connective Tissue Disease in the Inpatient Setting. CURRENT DERMATOLOGY REPORTS 2017. [DOI: 10.1007/s13671-017-0180-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
33
|
Peter JG, Lehloenya R, Dlamini S, Risma K, White KD, Konvinse KC, Phillips EJ. Severe Delayed Cutaneous and Systemic Reactions to Drugs: A Global Perspective on the Science and Art of Current Practice. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2017; 5:547-563. [PMID: 28483310 PMCID: PMC5424615 DOI: 10.1016/j.jaip.2017.01.025] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/11/2017] [Accepted: 01/18/2017] [Indexed: 12/17/2022]
Abstract
Most immune-mediated adverse drug reactions (IM-ADRs) involve the skin, and many have additional systemic features. Severe cutaneous adverse drug reactions (SCARs) are an uncommon, potentially life-threatening, and challenging subgroup of IM-ADRs with diverse clinical phenotypes, mechanisms, and offending drugs. T-cell-mediated immunopathology is central to these severe delayed reactions, but effector cells and cytokines differ by clinical phenotype. Strong HLA-gene associations have been elucidated for specific drug-SCAR IM-ADRs such as Stevens-Johnson syndrome/toxic epidermal necrolysis, although the mechanisms by which carriage of a specific HLA allele is necessary but not sufficient for the development of many IM-ADRs is still being defined. SCAR management is complicated by substantial short- and long-term morbidity/mortality and the potential need to treat ongoing comorbid disease with related medications. Multidisciplinary specialist teams at experienced units should care for patients. In the setting of SCAR, patient outcomes as well as preventive, diagnostic, treatment, and management approaches are often not generalizable, but rather context specific, driven by population HLA-genetics, the pharmacology and genetic risk factors of the implicated drug, severity of underlying comorbid disease necessitating ongoing treatments, and cost considerations. In this review, we update the basic and clinical science of SCAR diagnosis and management.
Collapse
Affiliation(s)
- Jonathan Grant Peter
- Division of Allergology and Clinical Immunology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Rannakoe Lehloenya
- Division of Dermatology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Sipho Dlamini
- Division of Infectious Diseases, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Kimberly Risma
- Division of Allergy, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Katie D White
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Katherine C Konvinse
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tenn
| | - Elizabeth J Phillips
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn; Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tenn; Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tenn; Institute for Immunology & Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia.
| |
Collapse
|
34
|
Ghosh P, Dewanji A. Sample size of the reference sample in a case-augmented study. Pharmacoepidemiol Drug Saf 2017; 26:528-534. [PMID: 28295862 DOI: 10.1002/pds.4191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 01/11/2017] [Accepted: 02/09/2017] [Indexed: 11/07/2022]
Abstract
The case-augmented study, in which a case sample is augmented with a reference (random) sample from the source population with only covariates information known, is becoming popular in different areas of applied science such as pharmacovigilance, ecology, and econometrics. In general, the case sample is available from some source (for example, hospital database, case registry, etc.); however, the reference sample is required to be drawn from the corresponding source population. The required minimum size of the reference sample is an important issue in this regard. In this work, we address the minimum sample size calculation and discuss related issues. Copyright © 2017 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Palash Ghosh
- Centre for Quantitative Medicine, Duke-National University of Singapore Medical School, Singapore
| | - Anup Dewanji
- Applied Statistics Unit, Indian Statistical Institute, Kolkata, India
| |
Collapse
|
35
|
Marija S, Ivana B, Nina R, Dragan N, Zlatko B, Branislav J, Jelena P, Dusica S. Toxic epidermal necrolysis in a child with lupus-associated pancreatitis. Rheumatol Int 2017; 37:1221-1226. [PMID: 28239770 DOI: 10.1007/s00296-017-3677-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/07/2017] [Indexed: 10/20/2022]
Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening dermatological conditions that are characterized by mucosal erosions, epidermal detachments and erosions. The most common causes of SJS and TEN are drugs; other causes such as systemic lupus erythematosus (SLE), vaccinations and infections have been rarely implicated. We present the case of a 14-year-old female patient with acute pancreatitis as an initial manifestation of systemic lupus erythematosus, complicated by the toxic epidermal necrolysis with a fatal outcome. She initially presented with abdominal pain, fever, vomiting, and intolerance to oral intake and elevated pancreatic enzyme levels. Systemic lupus erythematosus was diagnosed secondary when her condition has been already complicated by the toxic epidermal necrolysis. The administration of corticosteroids and high doses of intravenous immunoglobulin did not lead to positive effects in the treatment of our patient.
Collapse
Affiliation(s)
- Stevic Marija
- Department of Anesthesia, Faculty of Medicine, University of Belgrade, Tirsova 10, Belgrade, Serbia.
| | - Budic Ivana
- Department of Anesthesia, Faculty of Medicine, Clinical Centre Nis, University of Nis, Bulevar dr Zorana Djindjica 81, Nis, Serbia
| | - Ristic Nina
- Department of Gastroenterology, University Children's Hospital, Svetogorska 11, Belgrade, Serbia
| | - Nenadic Dragan
- Department of Anesthesia, Royal Victoria Hospital, 274 Grosnor RD, Belfast, BT, 12 6BA, UK
| | - Bokun Zlatko
- Department of Minimally Invasive Surgery, Zvezdara University Center, Dimitrija Tucovica 161, Belgrade, Serbia
| | - Jovanovic Branislav
- Department of Abdominal surgery, University Children's Hospital, Tirsova 10, Belgrade, Serbia
| | - Pejanovic Jelena
- Department of Abdominal surgery, University Children's Hospital, Tirsova 10, Belgrade, Serbia
| | - Simic Dusica
- Department of Anesthesia, Faculty of Medicine, University of Belgrade, Tirsova 10, Belgrade, Serbia
| |
Collapse
|
36
|
The Epidemiology of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in the UK. J Invest Dermatol 2017; 137:1240-1247. [PMID: 28202399 DOI: 10.1016/j.jid.2017.01.031] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/20/2017] [Accepted: 01/30/2017] [Indexed: 11/21/2022]
Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but life-threatening mucocutaneous diseases. SJS/TEN mostly manifest as a reaction to new drug use, but little is known about their incidence and epidemiology. We conducted a large observational study on the epidemiology of SJS/TEN using data from the UK-based Clinical Practice Research Datalink. Among 551 validated SJS/TEN patients, we calculated an incidence rate of 5.76 SJS/TEN cases per million person-years between 1995 and 2013, which was consistent throughout the study period and was highest in patients aged 1-10 years and 80 years or older. Within a 1:4 matched case-control analysis, black and Asian patients were at a 2-fold risk of SJS/TEN when compared with white patients. Among patients with epilepsy and gout, odds ratios for SJS/TEN were significantly increased only in the presence of recent new drug treatment with antiepileptics or allopurinol, respectively. We observed statistically significant associations between SJS/TEN and pre-existing depression, lupus erythematosus, recent pneumonia, chronic kidney disease, and active cancer, but confounding by drug use needs to be followed up. This large and longitudinal observational study on the epidemiology of SJS/TEN contributes to the understanding of this still underinvestigated severe skin disease in a European and largely white study population.
Collapse
|
37
|
Toxic Epidermal Necrolysis-Like Lesions and Systemic Lupus Erythematosus Possibly Triggered by Sulfasalazine. Case Rep Rheumatol 2016; 2016:4501937. [PMID: 27478675 PMCID: PMC4960340 DOI: 10.1155/2016/4501937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 06/18/2016] [Accepted: 06/23/2016] [Indexed: 11/17/2022] Open
Abstract
This case report describes a patient with arthritis of the large joints, bilateral sacroiliitis, and positive anti-SSA and anti-dsDNA antibody, who received sulfasalazine and shortly thereafter became critically ill. He developed toxic epidermal necrolysis, hemolytic anemia, lymphopenia, markedly elevated ferritin, and muscle wasting. A diagnosis of systemic lupus erythematosus was made, and mycophenolate mofetil and systemic glucocorticoids brought this severe disease under control. Toxic epidermal necrolysis-like lesions and hemophagocytic syndrome have been reported as manifestations of systemic lupus erythematosus. This patient possibly had spondyloarthritis or an undifferentiated connective tissue disease at presentation, and we suggest, based on the timing of events, that sulfasalazine may have acted as a trigger of the severe disease manifestations.
Collapse
|
38
|
Yu J, Brandling-Bennett H, Co DO, Nocton JJ, Stevens AM, Chiu YE. Toxic Epidermal Necrolysis-Like Cutaneous Lupus in Pediatric Patients: A Case Series and Review. Pediatrics 2016; 137:peds.2015-4497. [PMID: 27245834 DOI: 10.1542/peds.2015-4497] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2016] [Indexed: 11/24/2022] Open
Abstract
Bullous eruptions in patients with underlying systemic lupus erythematosus (LE) can mimic toxic-epidermal necrolysis (TEN), a rapidly progressive mucocutaneous reaction usually associated with medication use. Differentiating between classic drug-induced TEN and TEN-like cutaneous LE is important but difficult. We report a series of 3 patients with pediatric systemic LE who were admitted with severe worsening of skin disease resembling TEN. However, the initial photo-distribution of the eruption, subacute progression, limited mucosal involvement, mild systemic symptoms, supportive biopsy and laboratory results, and lack of culprit drugs was more suggestive of a TEN-like cutaneous LE. These patients recovered with various systemic immunosuppressive medications including methylprednisolone, intravenous immunoglobulin, and plasmapheresis. Our cases are rare and demonstrate key clinical and histologic features of TEN-like cutaneous LE in young patients and the importance of differentiating this entity from drug-induced TEN.
Collapse
Affiliation(s)
- JiaDe Yu
- Department of Dermatology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | - Dominic O Co
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin; Section of Rheumatology, Department of Pediatrics, and
| | - James J Nocton
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin; Section of Rheumatology, Department of Pediatrics, and
| | - Anne M Stevens
- Rheumatology, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington; and Division of Rheumatology, Department of Pediatrics, University of Washington, Seattle, Washington
| | - Yvonne E Chiu
- Division of Pediatric Dermatology, Departments of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin;
| |
Collapse
|
39
|
Jang HW, Shin JJ, Park JB, Son SW. Stevens-Johnson Syndrome-Like Skin Lesions in a Patient with Juvenile Systemic Lupus Erythematosus. Ann Dermatol 2016; 28:117-8. [PMID: 26848232 PMCID: PMC4737818 DOI: 10.5021/ad.2016.28.1.117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 03/16/2015] [Accepted: 03/21/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- Hee Won Jang
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| | - Jung Jin Shin
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| | - Jae Beom Park
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| | - Sang Wook Son
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
40
|
Merklen-Djafri C, Bessis D, Frances C, Poulalhon N, Debarbieux S, Cordel N, Lipsker D. Blisters and Loss of Epidermis in Patients With Lupus Erythematosus: A Clinicopathological Study of 22 Patients. Medicine (Baltimore) 2015; 94:e2102. [PMID: 26579826 PMCID: PMC4652835 DOI: 10.1097/md.0000000000002102] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The nosology of bullous lesions or equivalents (vesicles, erosions, and crusts) in patients with lupus erythematosus (LE) is rarely addressed.The primary aim of this study was to draw up a precise phenotypic inventory of such skin lesions; the secondary objective was to assess a potential relationship between the different types of loss of epidermis and extracutaneous lupus manifestations.We conducted a retrospective multicenter study including 22 patients with definite LE and bullous lesions or equivalents. All biopsies were reviewed. Patients were recruited in the dermatology departments of 6 centers. Patients were included if they met the diagnosis of systemic LE according to American College of Rheumatology and/or Systemic Lupus International Collaborating Clinics criteria or diagnosis of cutaneous LE based on classic clinical criteria and/or histological ascertainment of LE. Patients were recruited through clinician's memory and photographic collections.Three clinico-pathological patterns could be individualized. First, toxic epidermal necrolysis (TEN)-like, sheet-like, skin detachment; sun-exposure, mild mucosal involvement, and dermal mucin deposition allow differential diagnosis with classical Lyell syndrome. Second, vesiculo-bullae and/or crusting occurring on typical lesions of subacute cutaneous lupus erythematosus or chronic cutaneous lupus erythematosus. Third, tense vesicles and/or blisters with an underlying neutrophilic dermatosis and a usual response to dapsone.A careful analysis of 22 LE patients with epidermal detachment reveals 2 main pathomechanisms: a classic LE interface dermatitis, which can be hyperacute and lead to TEN-like skin detachment; and a neutrophilic dermatosis, with tense vesicles and/or blisters, including classic bullous LE.
Collapse
Affiliation(s)
- Carine Merklen-Djafri
- From the Faculté de Médecine, Université de Strasbourg; Clinique Dermatologique, Hôpitaux Universitaires de Strasbourg, Strasbourg (CM-D, DL); Faculté de Médecine, Université de Montpellier; Département de Dermatologie, Hôpital Saint Eloi, CHRU Montpellier, Montpellier (DB); Faculté de Médecine, Université Pierre-et-Marie-Curie Paris-VI, Service de Dermatologie Hôpital Tenon, Paris (CF); Faculté de Médecine, Université Claude Bernard Lyon 1, Service de Dermatologie, CHU Lyon Sud, Pierre-Bénite (NP, SD); and Service de Dermatologie-Médecine interne, CHU de Pointe-à-Pitre, Pointe-à-Pitre, Guadeloupe, (NC) France
| | | | | | | | | | | | | |
Collapse
|
41
|
Vázquez-Sanabria IL, Mercado-Seda R, Varela-Rosario N, Vilá LM. Efficacy of intravenous immunoglobulins in a patient with systemic lupus erythematosus presenting with Stevens-Johnson syndrome. BMJ Case Rep 2015. [PMID: 26202316 DOI: 10.1136/bcr-2015-211157] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Irma L Vázquez-Sanabria
- Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Rogelio Mercado-Seda
- Department of Dermatology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Noemí Varela-Rosario
- Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Luis M Vilá
- Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| |
Collapse
|
42
|
Bellakhal S, Ben Kaab B, Teyeb Z, Souissi A, Derbel F, Douggui MH. [Systemic lupus erythematosus presenting as Stevens-Johnson syndrome]. ACTA ACUST UNITED AC 2015; 63:222-3. [PMID: 26088436 DOI: 10.1016/j.patbio.2015.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
Abstract
Stevens-Johnson syndrome and toxic epidermal necrolysis are life-threatening dermatological conditions. Their most common cause is medication. However, in a small proportion of patients these dermatological conditions could be the first presentation of systemic lupus erythematosus. We now describe a 34-year-old patient who presented with manifestations of Stevens-Johnson as a first feature of systemic lupus erythematosus. Systemic lupus erythematosus reveled by Stevens-Johnson syndrome has been infrequently reviewed in the previous literature. This diagnosis should be considered when cutaneous adverse drug reactions occur without clear drug causality.
Collapse
Affiliation(s)
- S Bellakhal
- Service de médecine interne, hôpital des forces de sécurité intérieure, rue Tahar Ben Achour, 2070 La Marsa, Tunisie.
| | - B Ben Kaab
- Service de médecine interne, hôpital des forces de sécurité intérieure, rue Tahar Ben Achour, 2070 La Marsa, Tunisie
| | - Z Teyeb
- Service de médecine interne, hôpital des forces de sécurité intérieure, rue Tahar Ben Achour, 2070 La Marsa, Tunisie
| | - A Souissi
- Service de médecine interne, hôpital des forces de sécurité intérieure, rue Tahar Ben Achour, 2070 La Marsa, Tunisie
| | - F Derbel
- Service de médecine interne, hôpital des forces de sécurité intérieure, rue Tahar Ben Achour, 2070 La Marsa, Tunisie
| | - M-H Douggui
- Service de médecine interne, hôpital des forces de sécurité intérieure, rue Tahar Ben Achour, 2070 La Marsa, Tunisie
| |
Collapse
|
43
|
Systemic lupus erythematosus presenting as Stevens-Johnson syndrome/toxic epidermal necrolysis. J Clin Rheumatol 2014; 20:167-71. [PMID: 24662561 DOI: 10.1097/rhu.0000000000000088] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN)-like lesions in acute cutaneous lupus erythematosus [LE]) are an unusual manifestation of systemic LE. We describe a patient with widespread vesiculobullous lesions diagnosed as SJS/TEN-like acute cutaneous LE as the initial presentation of systemic LE. Stevens-Johnson syndrome/TEN-like LE may be differentiated from other vesiculobullous lesions by factors including a history of recent LE exacerbation, photodistribution of lesions, lack of a precipitating infection or medication exposure, minimal mucosal involvement, a prolonged course, response steroid treatment, and histologic and immunofluorescence findings. It is paramount to identify SJS/TEN-like LE as this condition requires early and aggressive intervention. The optimal treatment approach for SJS/TEN-like LE is unclear, and although some case reports have shown glucocorticoids to be useful, there are also reports of cases in which additional measures, such as intravenous immunoglobulin and plasmapheresis, were required to achieve a response. Our patient's condition was refractory to high-dose corticosteroids and intravenous immunoglobulin but was successfully treated using plasma exchange. As such, this treatment may hold potential for improving the care of other patients with refractory SJS/TEN-like LE.
Collapse
|
44
|
Ziemer M, Milkova L, Kunz M. Lupus erythematosus. Part II: clinical picture, diagnosis and treatment. J Dtsch Dermatol Ges 2014; 12:285-301; quiz 302. [PMID: 24423191 DOI: 10.1111/ddg.12254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 10/12/2013] [Indexed: 11/27/2022]
Abstract
Lupus erythematosus (LE) is an important dermatologic autoimmune disease. In many respects, it may be regarded as a model autoimmune disease due to its spectrum of autoimmune antibodies and involvement of different organ systems, as well as response to immunosuppressive agents which target B cells and T cells and their cytokines. A recently published article in this Journal summarized the most important knowledge about epidemiology, genetics, and immunology of LE. Here, the different clinical manifestations, diagnostic procedures and current therapeutic approaches will be described. Special emphasis is placed on different cutaneous manifestations of LE. In regard to treatment, the classic treatment approaches such as corticosteroids, methotrexate, chloroquine and hydroxychloroquine will be described. Lastly, new therapeutic approaches with specific monoclonal antibodies which are currently used in systemic LE, such as belimumab (Benlysta®), will be addressed. The most recent developments in this area could have implications even for purely cutaneous forms of LE.
Collapse
Affiliation(s)
- Mirjana Ziemer
- Department of Dermatology, Venereology and Allergology, University of Leipzig, Leipzig, Germany
| | | | | |
Collapse
|
45
|
Napolitano M, Giampetruzzi AR, Didona D, Papi M, Didona B. Toxic epidermal necrolysis-like acute cutaneous lupus erythematosus successfully treated with a single dose of etanercept: report of three cases. J Am Acad Dermatol 2014; 69:e303-5. [PMID: 24238188 DOI: 10.1016/j.jaad.2013.07.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 07/22/2013] [Accepted: 07/23/2013] [Indexed: 01/28/2023]
|
46
|
Ramasamy SN, Korb-Wells CS, Kannangara DRW, Smith MWH, Wang N, Roberts DM, Graham GG, Williams KM, Day RO. Allopurinol Hypersensitivity: A Systematic Review of All Published Cases, 1950–2012. Drug Saf 2013; 36:953-80. [DOI: 10.1007/s40264-013-0084-0] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
47
|
Wechsler J. [Case no. 2. Bullous dermatosis]. Ann Pathol 2013; 33:184-6. [PMID: 23790658 DOI: 10.1016/j.annpat.2013.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 04/09/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Janine Wechsler
- Département de pathologie, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
| |
Collapse
|
48
|
Lee JH, Ju IN, Cho HJ, Min HK, Hong YS. Toxic Epidermal Necrolysis by Ceftriaxone in Patient with Newly Diagnosed Systemic Lupus Erythematosus. JOURNAL OF RHEUMATIC DISEASES 2013. [DOI: 10.4078/jrd.2013.20.6.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Jae Ho Lee
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Il Nam Ju
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Hyung Jun Cho
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Hong Ki Min
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Yeon-Sik Hong
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Incheon, Korea
| |
Collapse
|
49
|
Ghauri AJ, Valenzuela AA, O'Donnell B, Selva D, Madge SN. Periorbital Discoid Lupus Erythematosus. Ophthalmology 2012; 119:2193-2194.e11. [DOI: 10.1016/j.ophtha.2012.05.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 05/24/2012] [Indexed: 12/18/2022] Open
|
50
|
Chandrashekar L. Update on cutaneous lupus erythematosus. Indian J Dermatol Venereol Leprol 2012; 78:129-32. [PMID: 22421640 DOI: 10.4103/0378-6323.93626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|