Norfloxacin-Induced Toxic Epidermal Necrolysis

2005 ◽  
Vol 39 (4) ◽  
pp. 768-770 ◽  
Author(s):  
Mustafa Turhan Sahin ◽  
Serap Ozturkcan ◽  
Isil Inanir ◽  
Elif E Filiz
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Causality Assessment ◽  
Case Reports ◽  
Oral Prednisolone ◽  
Stevens Johnson Syndrome ◽  
Medline Search ◽  
Case Summary ◽  
First Case ◽  
Johnson Syndrome ◽  
Severe Skin Reaction

OBJECTIVE: To report a case of toxic epidermal necrolysis (TEN) in a man who was treated with oral norfloxacin for prostatitis. CASE SUMMARY: A 40-year-old man presented with a severe skin reaction, which was diagnosed as TEN. He had received norfloxacin 800 mg/day over a 14-day period for prostatitis and, 10 days after finishing the treatment regimen, he developed cutaneous and mucous lesions typical of TEN. After a prolonged hospitalization and treatment with oral prednisolone therapy, fluid resuscitation, and wound dressing, the man recovered. DISCUSSION: TEN is an infrequent, yet often fatal, severe systemic and cutaneous disease that is most often an adverse drug reaction. There are few case reports of TEN induced by fluoroquinolones. A MEDLINE search (1966–February 2005) revealed no reports of toxic epidermal necrolysis, but one incidence of Stevens—Johnson syndrome due to norfloxacin therapy. An objective causality assessment suggests that TEN was probably related to norfloxacin in this patient. CONCLUSIONS: To our knowledge, this is the first case of TEN associated with the use of oral norfloxacin. We hope that this case report creates awareness that norfloxacin-induced TEN is possible.

Possible Cefotaxime-Induced Stevens–Johnson Syndrome

2003 ◽  
Vol 37 (6) ◽  
pp. 812-814 ◽  
Author(s):  
Evagelos N Liberopoulos ◽  
George L Liamis ◽  
Moses S Elisaf
Keyword(s):  
Case Control Study ◽  
Causality Assessment ◽  
Clinical Manifestations ◽  
Underlying Mechanism ◽  
Upper Urinary Tract ◽  
Stevens Johnson Syndrome ◽  
Case Summary ◽  
Johnson Syndrome ◽  
Increased Risk ◽  
Control Study

OBJECTIVE: To report a case of possible cefotaxime-induced Stevens–Johnson syndrome (SJS). CASE SUMMARY: A 72-year-old woman with an upper urinary tract infection developed erosions and blisters on the skin and the mucous membranes, as well as fever and prostration, soon after the administration of cefotaxime. This presentation is consistent with the features of SJS. Resolution of the clinical manifestations was observed after discontinuation of the drug; all other drugs, infections, or immunologic disorders that could have caused this syndrome were carefully excluded. An objective causality assessment revealed that SJS was possibly associated with the use of cefotaxime. DISCUSSION: Although cephalosporins have been associated with an increased risk for SJS and cefotaxime has been suspected of being associated with SJS in a previous case–control study, this is the first full report for cefotaxime-related SJS in the literature. An immunologically mediated reaction may be the underlying mechanism. CONCLUSIONS: Although cefotaxime administration seems to be the underlying cause of the SJS observed in our patient, establishment of a definite causal relationship requires additional cases and supportive data.

Suspected Lamotrigine-Induced Toxic Epidermal Necrolysis

1997 ◽  
Vol 31 (6) ◽  
pp. 720-723 ◽  
Author(s):  
Julie J Chaffin ◽  
Steven M Davis
Keyword(s):  
Valproic Acid ◽  
Toxic Epidermal Necrolysis ◽  
Case Reports ◽  
Stevens Johnson Syndrome ◽  
Complex Partial Seizures ◽  
Skin Reactions ◽  
Johnson Syndrome ◽  
Patient Reported ◽  
History Of ◽  
Relationship Of

OBJECTIVE: To describe a patient who developed toxic epidermal necrolysis (TEN) possibly secondary to lamotrigine use. CASE SUMMARY: A 74-year-old white man with a history of probable complex partial seizures was admitted to the neurology service for a prolonged postictal state. His antiepileptic regimen was changed while he was in the hospital to include lamotrigine. After 19 days of hospitalization and 14 days of lamotrigine therapy, the patient became febrile. The next day he developed a rash which progressed within 4 days to TEN, diagnosed by skin biopsy. All suspected drugs were discontinued, including lamotrigine. The patient was treated with hydrotherapy in the burn unit. His symptoms improved and he was discharged from the hospital 26 days after the rash developed. DISCUSSION: During lamotrigine's premarketing clinical trials, the manufacturer reported several cases of Stevens-Johnson syndrome and TEN. There are several published case reports of lamotrigine-induced severe skin reactions. All of these reports included patients being treated with both valproic acid and lamotrigine. Our patient was exposed to phenytoin, carbamazepine, clindamycin, and lamotrigine, but not valproic acid. The patient reported prior use of phenytoin with no skin rash. Carbamazepine was the antiepileptic drug the patient was maintained on prior to his hospital admission, and the symptoms of TEN resolved while he was still receiving carbamazepine. The patient received only two doses of clindamycin, which makes this agent an unlikely cause of TEN. CONCLUSIONS: Because of the temporal relationship of the onset of the patient's rash and several drugs that are known to cause severe rashes, it is not certain which drug was the definite culprit. However, based on the evidence from the literature, lamotrigine appears to be the causative agent.

scholarly journals Levofloxacin induced Stevens-Johnson syndrome/ toxic epidermal necrolysis overlap syndrome: case reports

2014 ◽  
Vol 4 (S3) ◽  
Author(s):  
Maria Gloria Aversano ◽  
Jan Schroeder ◽  
Antonella Citterio ◽  
Joseph Scibilia ◽  
Chiara Gamba ◽  
...  
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Case Reports ◽  
Overlap Syndrome ◽  
Stevens Johnson Syndrome ◽  
Johnson Syndrome

scholarly journals Rifampicin- and allopurinol-induced Stevens-Johnson syndrome: A case series

2021 ◽  
Vol 65 ◽  
pp. 51-54
Author(s):  
Bhavana Srivastava ◽  
Reena Bhardwaj ◽  
Renu Khanchandani ◽  
Zafar Masood Ansari ◽  
Gunjita Belwal
Keyword(s):  
Adverse Effects ◽  
Pulmonary Tuberculosis ◽  
Causality Assessment ◽  
Case Series ◽  
Young Male ◽  
Stevens Johnson Syndrome ◽  
Johnson Syndrome ◽  
Mucous Membranes ◽  
Life Threatening ◽  
Severe Skin Reaction

Stevens-Johnson syndrome (SJS) is a rare, serious disorder and may be life threatening affecting mainly mucocutaneous tissues. It is a type of generalised, multisystemic hypersensitivity reaction directly linked to the drug intake. It is one of the few serious adverse effects of drugs involving skin and mucous membranes which are characterised by rash, bullae and blisters spread on skin, mucous membranes, swelling with erosive lesions on lips and face and hyperpigmentation. Normally, SJS is a self-resolving condition but it has potential to be converted into life-threatening disease. Here, we describe and present a case series of SJS inflicted by rifampicin and allopurinol. First one is a 28-year-old-female and second case is a 50-year-old male, both received rifampicin for pulmonary tuberculosis. Third patient is a 22-year-old young male taken allopurinol for hyperuricemia. All these patients noticed a severe skin reaction which is a part of erythema multiforme spectrum. Causality assessment was done in these patients with the help of Naranjo’s algorithm and diagnosed as cases of SJS.

scholarly journals The Epidemiology of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in China

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Shang-Chen Yang ◽  
Sindy Hu ◽  
Sheng-Zheng Zhang ◽  
Jin-wen Huang ◽  
Jing Zhang ◽  
...  
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Case Reports ◽  
Statistical Significance ◽  
Epidemiologic Studies ◽  
Stevens Johnson Syndrome ◽  
Systemic Steroid ◽  
China National Knowledge Infrastructure ◽  
Johnson Syndrome ◽  
Life Threatening ◽  
Medical University

Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are life-threatening disease. However, there are only few epidemiologic studies of SJS/TEN from China. To analyze the clinical characteristics, causality, and outcome of treatment for SJS/TEN in China, we reviewed case reports of patients with SJS/TEN from the China National Knowledge Infrastructure (CNKI) and Wanfang database from 2006 to 2016 and patients with SJS/TEN who were admitted to the First Affiliated Hospital of Fujian Medical University during the same period. There were 166 patients enrolled, including 70 SJS, 2 SJS/TEN overlap, and 94 TEN. The most common offending drugs were antibiotics (29.5%) and anticonvulsants (24.1%). Carbamazepine, allopurinol, and penicillins were the most common single offending drugs (17.5%, 9.6%, and 7.2%). Chinese patent medicines accounted for 5.4%. There were 76 (45.8%) patients receiving systemic steroid and intravenous immunoglobulin (IVIG) in combination therapy, especially for TEN (80.3%), and others were treated with systemic steroids alone. Mortality rate of combination treatment comparing with steroid alone in TEN patients had no statistical significance. In conclusion, carbamazepine and allopurinol were the leading causative drugs for SJS/TEN in China. Combination of IVIG and steroids is a common treatment for TEN, but its efficacy in improving mortality needs further investigation.

scholarly journals A case report of Stevens-Johnson syndrome and toxic epidermal necrolysis due to diclofenac sodium

2020 ◽  
Vol 9 (7) ◽  
pp. 1132
Author(s):  
Sreenivasa Rao Bendi ◽  
Tarun Kumar Suvvari
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Diclofenac Sodium ◽  
Skin Surface ◽  
Severe Form ◽  
Stevens Johnson Syndrome ◽  
Phenyl Acetic Acid ◽  
Disease Spectrum ◽  
Johnson Syndrome ◽  
Mucous Membranes ◽  
Severe Skin Reaction

Stevens-Johnson syndrome (SJS) is a severe skin reaction most often triggered by particular drugs in most of the cases. A more severe form of the condition is called toxic epidermal necrolysis (TEN) which involves more than 30% of the skin surface and extensive damage to the mucous membranes. SJS and TEN previously were thought to be separate conditions, but they are now considered part of a disease spectrum. The main drugs which induce SJS were anti-gout drugs, anti-epileptics, analgesics, NSAIDs and antibiotics. Diclofenac which is a NSAID and phenyl acetic acid derivative that rarely causes SJS. Although diclofenac induced Stevens-Johnson syndrome is reported very rare among adults, it shouldn’t be neglected. In this report we mentioned about the Stevens-Johnson syndrome (SJS) which was later developed into TEN due to usage diclofenac sodium, in a 65 years old female patient.

scholarly journals A case report of toxic epidermal necrolysis (TEN) in a patient with COVID-19 treated with hydroxychloroquine: are these two partners in crime?

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Carlo Maria Rossi ◽  
Flavio Niccolò Beretta ◽  
Grazia Traverso ◽  
Sandro Mancarella ◽  
Davide Zenoni
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Fatal Outcome ◽  
Total Body Surface Area ◽  
Stevens Johnson Syndrome ◽  
First Case ◽  
Cutaneous Adverse Reaction ◽  
Johnson Syndrome ◽  
Mucous Membranes ◽  
Total Body ◽  
The Moment

Abstract Background Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) is the most Serious Cutaneous Adverse Reaction (SCAR) often with a fatal outcome. Coronavirus Disease (COVID-19) is caused by Severe Acute Respiratory Syndrome–Coronavirus—2 (SARS-COV2) and is an emergent pandemic for which no cure exist at the moment. Several drugs have been tried often with scant clinical evidence and safety. Case presentation Here we report the case of 78-years-old woman with cardiometabolic syndrome and COVID-19. A multidrug regimen including others hydroxychloroquine, antibiotics, dexamethasone and paracetamol, low-molecular-weight-heparin and potassium canrenoate was started. After almost 3 weeks, the patient started to display a violaceous rash initially involving the flexural folds atypical targetoid lesions and showing a very fast extension, blister formation and skin detachments of approximately 70% of the total body surface area and mucous membranes involvement consistent with toxic epidermal necrolysis (TEN). The ALDEN algorithm was calculated inserting all drugs given to the patient in the 28 days preceding the onset of the skin manifestations. The highest score retrieved was for hydroxychloroquine. Other less suspicious drugs were piperacillin/tazobactam, ceftriaxone and levofloxacin. Conclusions To our knowledge, this is the first case of TEN in a patient suffering from COVID-19 probably associated with hydroxychloroquine. Given the activation of the immune system syndrome induced by the virus and the widespread off-label use of this drug, we suggest a careful monitoring of skin and mucous membranes in all COVID-19 positive patients treated with hydroxychloroquine in order to early detect early signs of toxicities.

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