Abstract
Toxic epidermal necrolysis (TEN) is a rare and serious but life-threatening dermolytic cutaneous reaction characterized by diffuse and severe exfoliation and destruction of the epidermis of skin and mucosa due to immunological damage of the epidermis which can bring about sepsis and respiratory distress. Drugs are the most common inflicting agents in the generation of TEN. Among drugs, antiepileptics, antipsychotics, and sulfa-drugs are common causes of TEN. Valproate is one of the most common drugs prescribed for epilepsy, was found as causative agent in TEN in very few cases. Among sulfonamides, sulfamethoxazole is commonly used antibiotic which can cause TEN. The evidence-based treatment guidelines are lacking, so the best approach is to recognize and evade potential risk factors and to deliver intensive supportive care immediately to reduce morbidity and mortality. The aim of this case series is to focus on valproate and trimethoprim-sulfamethoxazole (TMP-SMX)-induced TEN, which are commonly used drugs. Here, we present a case series of TEN inflicted by TMP-SMX and sodium valproate in a 23-year-old female and 10-year-old boy, respectively, with successful recovery.
Highlights
Toxic epidermal necrolysis (TEN) is a rare dermatological condition presenting with characteristic erythematous maculopapular rashes progressing into diffuse exfoliation of skin and mucous membranes along with constitutional symptoms and internal organ involvement [1]
On the basis of history of intake of inflicting drugs, thorough clinical examinations and pathological findings, these patients were diagnosed as a case of TEN which is due to sulfamethoxazole and sodium valproate intake in the first and second case, respectively
There was a common occurrence of adverse drug reaction in the form of TEN due to TMP-SMX as well as sodium valproate administration in two separate cases, we reported it to emphasize the important fact that extreme caution should be exercised while prescribing and administration of antimicrobial and anticonvulsant drugs, especially TMP-SMX and valproate to prevent this type of reaction
Summary
Toxic epidermal necrolysis (TEN) is a rare dermatological condition presenting with characteristic erythematous maculopapular rashes progressing into diffuse exfoliation of skin and mucous membranes along with constitutional symptoms and internal organ involvement [1]. Intervention, and treatment of this serious adverse effect in time are the gold standard and can modify the progression of the disease condition and save the precious life of a patient In this case series, we present first case of a 23-year-old female who developed TEN without any prodromal symptoms following oral dose of TMP-SMX. Patient 2 A 10-year-old boy presented with an extensive exfoliation of skin involving maximum part of the body 6 days after initiation of sodium valproate therapy for his seizure disorder. This patient had denudation of lip and oral mucosa. On the basis of history of intake of inflicting drugs, thorough clinical examinations and pathological findings, these patients were diagnosed as a case of TEN which is due to sulfamethoxazole and sodium valproate intake in the first and second case, respectively
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