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Lekshmipriya K, Pradeesh A, Vasudevan B, Dash M, Sood A, Gera V. An observational study of severe cutaneous adverse reactions at a tertiary care teaching hospital. Med J Armed Forces India 2023; 79:S209-S216. [PMID: 38144617 PMCID: PMC10746803 DOI: 10.1016/j.mjafi.2022.06.011] [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: 09/19/2021] [Accepted: 06/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background The term severe cutaneous adverse reactions to drugs (SCAR) comprises of acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms complex (DRESS), Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS-TEN) and drug-induced erythroderma or exfoliative dermatitis (ED). The present study aims at describing the epidemiological and clinical profile, probable cause and the extent of morbidity and mortality in patients with severe cutaneous adverse drug reactions. Methods An observational study of all cases of SCAR presenting to our centre during the period from Jun 2018 to July 2019 was carried out. Results A total of 24 SCAR patients were studied. Most of the patients were in the age group of 11-20 years. The commonest reactions observed were SJS-TEN (54.2%) followed by DRESS (42%). Antibiotics are the most common cause of SJS-TEN, whereas almost all the drug groups were implicated equally in DRESS. No causative drug could be found in two of the SJS-TEN patients. These patients had raised atypical targetoid lesions as well as evidence of viral reactivation which could have been the probable trigger for the SCAR. A total of five patients (20.8%) died during treatment in hospital, and the percentage mortality was highest in SJS-TEN. Conclusion Nondrug aetiologies for SJS-TEN are on the rise, and this was observed in this study too. Viral reactivation may be the commonest aetiology in such cases, and the morphology of the rash can give a clue to such cases.
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Affiliation(s)
- K. Lekshmipriya
- Associate Professor, Department of Dermatology, Armed Forces Medical College, Pune, India
| | - A. Pradeesh
- Consultant (Dermatologist), Dr. Pradeesh’s Skin & Hair Clinic, Tirupathur, Tamil Nadu, India
| | - Biju Vasudevan
- Professor & Head, Department of Dermatology, Armed Forces Medical College, Pune, India
| | - Mahashweta Dash
- Graded Specialist (Dermatology & Venereology), 159 General Hospital, C/o 56 APO, India
| | - Aradhana Sood
- Consultant (Dermatology), Manipal Hospital, Hebbal, Bangalore, India
| | - Vinay Gera
- Senior Adviser (Dermatology & Venereology), Command Hospital (Southern Command), Pune, India
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Li H, Zhang J, Chen Y. Methotrexate-induced toxic epidermal necrolysis in a child undergoing a combination therapy for systemic lupus erythematosus. Ital J Dermatol Venerol 2020; 156:263-264. [PMID: 33034436 DOI: 10.23736/s2784-8671.20.06621-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Huotao Li
- Guangdong Provincial Dermatology Hospital, Southern Medical University, Guangzhou, China.,Hexian Memorial Hospital of Panyu District, Guangzhou, China
| | - Jiao Zhang
- Guangdong Provincial Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Yongfeng Chen
- Guangdong Provincial Dermatology Hospital, Southern Medical University, Guangzhou, China -
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Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Children With Non-Hodgkin Lymphoma. J Pediatr Hematol Oncol 2020; 42:e310-e314. [PMID: 32576784 DOI: 10.1097/mph.0000000000001851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The aim of this study is to evaluate the clinical and laboratory findings of pediatric patients with non-Hodgkin lymphoma (NHL) who developed Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Between 2006 and 2018, the medical records of child patients with NHL who developed SJS and TEN were reviewed retrospectively. SJS/TEN developed in 7 of 70 patients with NHL (10%). The pathologic subgroups of the patients with SJS/TEN were ALK-negative anaplastic large cell lymphoma (n: 3), Burkitt lymphoma (n: 2), lymphoblastic lymphoma (n: 1), and primary mediastinal B-cell lymphoma (n: 1). Five patients had TEN, 1 patient had SJS/TEN, and 1 patient developed only SJS. In 5 patients, both steroids and intravenous immunoglobulin were administered for treatment, and clinical improvement was achieved in 3 of these patients. Only steroid treatment was used for 1 patient, whereas for the other patient, intravenous immunoglobin was preferred. In addition, N-acetylcysteine treatment was administered for these 2 patients. Four patients with acute renal failure died, and it was found that SJS/TEN is observed more frequently in patients with NHL in which intensive treatment protocols with high-dose methotrexate are used more than with other childhood malignant diseases. Early diagnosis and administration of appropriate and supportive treatment approaches may improve the prognosis.
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Masatkar V, Nagure A, Gupta LK. Unusual and Interesting Adverse Cutaneous Drug Reactions. Indian J Dermatol 2018; 63:107-116. [PMID: 29692451 PMCID: PMC5903039 DOI: 10.4103/ijd.ijd_584_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Any drug can cause any rash! Cutaneous adverse drug reactions (CADRs) are great mimickers and can be included in the differential diagnosis of any inflammatory dermatoses. Several drugs can cause rash of similar morphology and the same drug can cause rash of different morphology. While some common and specific drug reaction patterns are recognized easily by the clinicians, many a times unusual and interesting patterns can be induced by drug(s), thus leading to erroneous diagnosis and mistreatment. This review aims to familiarize clinicians with some rare, yet interesting patterns of CADR.
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Affiliation(s)
- Vaishali Masatkar
- Department of Dermatology, Ananta Institute of Medical Sciences and Research Centre, Rajsamand, India
| | - Ashok Nagure
- Department of Dermatology, Bidar Institute of Medical Sciences, Bidar, Karnataka, India
| | - Lalit Kumar Gupta
- Department of Dermatology, RNT Medical College, Udaipur, Rajasthan, India
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Chen TJ, Chung WH, Chen CB, Hui RCY, Huang YH, Lu YT, Wang CW, Wang KH, Yang LC, Hung SI. Methotrexate-induced epidermal necrosis: A case series of 24 patients. J Am Acad Dermatol 2017; 77:247-255.e2. [PMID: 28499754 DOI: 10.1016/j.jaad.2017.02.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/07/2017] [Accepted: 02/07/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Methotrexate-induced epidermal necrosis (MEN) is a rare but life-threatening cutaneous reaction that mimics Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). OBJECTIVES To investigate the clinicopathology, risk factors, and prognostic factors of MEN. METHODS We enrolled 24 patients with MEN and 150 controls and analyzed the demographics, pathology, and plasma concentrations of methotrexate (MTX). RESULTS Patients with MEN showed extensive skin necrosis (mean, 33.2% total body surface area) but no target lesions. The histopathology displayed keratinocyte dystrophy. Early signs of MEN included painful skin erosions, oral ulcers, and leukopenia/thrombocytopenia. Although 79.2% patients received leucovorin treatment, there was 16.7% mortality. Risk factors for MEN included older age (>60 years), chronic kidney disease, and high initial dosage of MTX without folic acid supplementation. Renal insufficiency delayed MTX clearance. Severe renal disease and leukopenia predicted poor prognosis in MEN, but none of the SCORe of Toxic Epidermal Necrosis criteria were associated with mortality of MEN. LIMITATIONS The study was limited by the small sample size. CONCLUSION MEN exhibited distinct clinicopathologic features from SJS/TEN. Recognition of the early signs and prognostic factors is important, because the rapid institution of leucovorin may be helpful. To reduce the risk of MEN, physicians should avoid prescribing MTX to high-risk patients and titrate the dosage slowly upward with folic acid supplementation.
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Affiliation(s)
- Ting-Jui Chen
- Department and Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Dermatology, Wan Fang Hospital, Taipei Medical University Hospital, Taipei, Taiwan
| | - Wen-Hung Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, and Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Bing Chen
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, and Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Rosaline Chung-Yee Hui
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, and Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Huei Huang
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, and Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yueh-Tsung Lu
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, and Keelung, Taiwan
| | - Chang-Wei Wang
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, and Keelung, Taiwan
| | - Kuo-Hsien Wang
- Department of Dermatology, Wan Fang Hospital, Taipei Medical University Hospital, Taipei, Taiwan
| | - Li-Cheng Yang
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, and Keelung, Taiwan
| | - Shuen-Iu Hung
- Department and Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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