Case Of Stevens-Johnson Syndrome Research Articles

A case of Stevens-Johnson syndrome without skin lesions

A case of Stevens-Johnson syndrome without skin lesions

COVISHIELD Vaccine–Induced Ocular Stevens-Johnson Syndrome: A Case Report

Abstract: Stevens-Johnson syndrome (SJS) is an acute inflammatory vesiculobullous reaction of the skin and mucosa. The involvement of the ocular mucosa in these cases leads to ocular SJS. The most commonly reported etiological agents for SJS are drugs, viral infections, and vaccination. Here, we present the first ever reported case of ocular SJS occurring secondary to COVISHIELD vaccination, wherein a 62-year-old had an episode of acute SJS within a week of the COVISHIELD booster dose. She presented to us 6 months after the acute episode with infectious keratitis in the right eye and descemetocele in the left eye in chronic SJS with severe bilateral lid keratinization in all 4 lids and healed skin pigmentation typical of SJS sequelae.

Acetaminophen induced Stevens Johnson syndrome - Toxic Epidermal Necrolysis Overlap Syndrome: A rare Adverse Reaction

Stevens Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are hyper sensitive life - threatening rare dermatological reactions. In SJS - TEN overlap syndrome, the extent and severity of epidermal detachment is 10- 30%. Drugs like sulfonamides, nonsteroidal anti- inflammatory agents, antibiotics and anticonvulsants are the commonest precipitants. Here, we present a rare case of SJS - TEN overlap syndrome in a previously normal 11 years old girl after acetaminophen intake for fever. This case report is intended to make paediatricians aware that the adverse reaction like SJS - TEN overlap syndrome can develop with a drug like acetaminophen which is supposed to be the safest antipyretic in paediatrics.

Pembrolizumab-induced Stevens-Johnson syndrome in advanced squamous cell carcinoma of the lung: A case report and review of literature

BACKGROUNDFor advanced lung squamous cell carcinoma, immune checkpoint inhibitors (ICIs) have been regarded as one of the optimal therapies. While immune-related adverse events (irAEs) are common in ICI treatment, cutaneous toxicities are among the most common irAEs. Most immune-related skin toxicity grades are low, and the prognosis is good. However, Stevens-Johnson syndrome (SJS) is a rare but extremely severe cutaneous adverse drug reaction with high mortality.CASE SUMMARYWe report a rare case of SJS induced by pembrolizumab. The case involved a 68-year-old female who was diagnosed with advanced squamous cell carcinoma of the lung. SJS appeared after one cycle of immunotherapy combined with chemotherapy. After treatment with prednisone hormone symptoms, anti-infection, gamma globulin, and antipruritic agents, the skin toxicity of the patients gradually decreased and eventually disappeared. Although the antitumor treatment was stopped due to serious adverse reactions, the tumor of the patient remained stable for nearly half a year after one cycle of immune therapy combined with chemotherapy, which also corroborates the delayed effect of immunotherapy.CONCLUSIONWe believe our report can provide some references for the treatment of SJS and the treatment of immune-related adverse reactions.

Case Series of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis With Nivolumab and Nivolumab/ Ipilimumab Combination Therapy in Metastatic Melanoma.

Nivolumab (anti PD-1 antibody) and ipilimumab (anti CTLA-4 antibody) are immune checkpoint inhibitors (ICI) that effectively stimulate the native T cell response and lead to an antitumor response. The medications have been approved for the treatment of metastatic melanoma. However, ICIs are associated with higher risk for cutaneous immune-related adverse events (irAEs). Although most of the adverse events present as maculopapular rash, some patients develop Stevens-Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis which are dermatologic emergencies with high mortality. We report a fatal case of SJS associated with nivolumab and a non-fatal case of TEN with nivolumab/ipilimumab combination therapy in patients with metastatic melanoma. It is also not unusual to develop SJS or TEN after weeks or months on checkpoint inhibitor therapy. Given the high rate for mortality, dermatologists and other clinicians should closely follow any rash from these immunotherapies due to the risk for future development of SJS or TEN. J Drugs Dermatol. 2022;21(5):529-530. doi:10.36849/JDD.6559.

A Case Study of Oxcarbazepine-induced Stevens-johnson Syndrome

Background: Stevens–Johnson syndrome is a rare potentially fatal disorder characterized by mucosal membrane erosions, bullous skin lesions and epidermal detachment.
 Objective: This case report discusses a case of a patient who developed seizures and macular rashes as a result of Stevens–Johnson syndrome induced by oxcarbazepine.
 Case presentation: An eight-year-old girl was admitted to hospital with complaints of seizure episodes that occurred during sleep, characterized by drooling, jerky stiff upper limbs, throat sounds, and blue lips. Patient was born with severe intrauterine growth retardation and microcephaly and was diagnosed with congenital cytomegalovirus (CMV). EEG results confirmed that focal epilepsy was the underlying cause of seizures. The patient was given oxcarbazepine as an anticonvulsant medication after confirming epilepsy diagnosis. However, after two weeks of treatment, patient developed rashes and skin lesions all over her body except hands. These skin lesions and rashes were red and tan in color, swollen, itchy, scaly, dry, popular, macular and patchy. The skin detachment was less than 10% of BSA (body surface area). The Naranjo algorithm was used to check the probability of a drug reaction and through the WHO-UMC criteria for causality, it was decided that oxcarbazepine induced the syndrome. Hence, patient was diagnosed as a case of Stevens-Johnson syndrome.
 Conclusion:Stevens–Johnson syndrome is a rare condition that can cause rashes and epidermal detachment. It can be caused by adverse effects of medications; however, exact pathogenesis is unknown. Therefore, studies on large number of patients are required to understand the pathogenesis of oxcarbazepine-induced SJS.

Chronic Analgesic (NSAID induced) SJS: A Case Report

In the contemporary era, use of drugs is the dominant paradigm of health care. The most quotidiandrug used for fever and pain is paracetamol. Although adverse reactions to paracetamol in India arerare, at times they can cause life-threatening situations. Stevens-Johnson syndrome (SJS) is one suchpotentially lethal adverse drug reaction. The most reported cases of analgesic-induced SJS were dueto oxicams or propionic acid derivatives. There are very few detailed reports of SJS due to the useof paracetamol. We report a case of SJS, which occurred due to the use of paracetamol. The clinicalfeatures of this condition and multidisciplinary management of the patient are described in brief.

S1934 Acute Colonic Ischemia: A Rare Complication of Stevens-Johnson Syndrome

Introduction: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening mucocutaneous reactions characterized by necrotic epidermal detachment and blister formation. Mucosal involvement of oropharyngeal, ocular, and urogenital surfaces is most common, but involvement of the small bowel and colon is distinctively rare. We present a unique case of SJS with colonic involvement resulting in acute colonic ischemia. Case description/methods: A 36 year-old female with systemic lupus erythematosus, hypertension, and asthma presented with one day of fever and emesis after taking ibuprofen for sore throat. On admission, she was febrile to 104°F. Laboratory evaluation was non-diagnostic. A diffuse pink morbilliform rash was noted, which rapidly progressed to widespread erythema, targetoid lesions, and bullae. Skin biopsy was consistent with SJS. A week into hospitalization, she developed respiratory failure requiring intubation and transfer to the intensive care unit. CT of the chest, abdomen, and pelvis revealed multifocal pneumonia but normal small and large bowel. She was treated with broad spectrum antibiotics and one dose of subcutaneous etanercept. The patient then developed worsening abdominal pain and distension. Repeat abdominal CT showed marked diffuse colonic distension with pneumatosis from the cecum to proximal transverse colon (Fig. 1). Abdominal arterial vasculature was patent. Exploratory laparotomy confirmed full thickness colonic ischemia. She underwent right and transverse colectomy with end ileostomy. Histology of the colonic mucosa was consistent with ischemia. She was started on IVIG and IV methylprednisolone therapy. The patient gradually improved. Her recovery was complicated by intra-abdominal and pelvic abscesses requiring percutaneous drainage, along with persistent abdominal pain. Further evaluation of her pain included a normal ileoscopy and upper endoscopy and an abdominal CT demonstrating enteritis which was managed with supportive care. The patient was ultimately discharged to a rehabilitation facility. Discussion: SJS/TEN is a potentially fatal and often drug-induced dermatologic reaction involving mucocutaneous membranes. We present a case of SJS thought secondary to ibuprofen use resulting in acute colonic ischemia, which is infrequently encountered and associated with significant morbidity. Clinicians must maintain high suspicion for gastrointestinal involvement of SJS/TEN to allow for prompt diagnosis and intervention.Figure 1.: Colonoscopy revealing a 5 cm polypoid mass at the hepatic flexure.

Синдром Стивенса — Джонсона у подростка: диагностика и лечение (клинический случай)

Авторами представлен клинический случай синдрома Стивенса — Джонсона у подростка, жителя Тернопольской области, который был госпитализирован в реанимационное отделение Тернопольской областной детской клинической больницы. Особенностью данного клинического случая является то, что у пациента была тяжелая форма токсического эпидермального некролиза, который сопровождался лихорадкой, поражением кожи, симптомом Никольского. У мальчика развился характерный кожный синдром, сопровождающийся формированием пузырей на коже, эрозий на слизистых. Парентеральное введение преднизолона из расчета 10 мг/кг на фоне поддержания водного, электролитного и белкового баланса привело к выраженному положительному эффекту и снизило риск ухудшения состояния больного.

Dosing Reduction of Levomethadone in Male Patients in Opioids‐Dependent Maintenance Therapy in the South East Italian Area

Background The study has the primary objective of assessing the efficacy/safety of rac-methadone, levomethadone, and buprenorphine in maintenance patients and naïve, in pharmacological polytherapy. The secondary objective of the study is to evaluate efficacy/safety of the treatments in subgroups of patients with comorbidity under psychological support. Methods The primary endpoint was the temporal reduction of urinary positivity to the substance of abuse evaluated every three months, expressed as a percentage of responders out of the total number of recruits. Secondary endpoints were: the safety assessment. Psychopathology was assessed by ASI, Scl90, and a novel COVID-19 questioner. Results To date, 211 patients have been recruited, made up of 81% by males with an average age of 44.41 +5.24 and 19% by females with an average age of 43.16 + 2.89, over 98% of patients recruited are of Italian Caucasian. At recruitment, 75% of patients were already on treatment, most of them from less than (> 80%) to 1 year. 20% + 1.3, 12% + 5.9, 7%+5, and 5% + 0.9 had psychiatric, infectious, cardiological, and metabolic comorbidity. At enrollment, 65% of female patients were treated with rac-methadone at a mean dose of 55 mg + 10 mg/day, 35% were treated with levomethadone at the dose of 45.11 mg + 6.5 mg/ day and the rest were treated with buprenorphine/naloxone at a dosage of 4 mg + 2.62 mg/day. In the male group, 50% of patients were treated with rac-methadone with a mean dosage of 57.21 mg +10.88 mg/day, 25% were treated with levomethadone with a mean dosage of 28.75 mg + 7.5 mg/day and the rest were treated with buprenorphine/naloxone at a mean dosage of 8 mg +3.62 mg/day. The starting Craving was respectively 32/100 in males and 31/100 in females, according to VAS. Out of 30% of patients who have completed their visits to date, 180 days after recruitment showed stability in urinary methadone positivity with a marked decrease in heroin positivity -53% + 4%, cannabinols -48% + 2% and cocaine -37% + 6%. The observed ADRs were: constipation, muscle fatigue, and one case of Stevens-Johnson syndrome. 60 patients at enrollment showed a mean QTc of 430.2 +12.4, mean BPM of 75.23 + 5.3, systolic and diastolic blood pressure of 122.5 + 2.14 and 81.4 + 3.3 mmHg respectively, which remained unchanged. Adverse events of any nature were: decreased willpower, job loss, increased alcohol use, changes in personality including dullness and depression. Conclusion The patients were stabilized after 180 days of observation in our SERDs with a marked decreased dosing of levomethadone in males but with minor dosing reduction in the female. Whether this is due to factors affecting PD/PK is under investigation.

口腔咽喉頭の粘膜病変を呈したStevens-Johnson 症候群例

口腔咽喉頭の粘膜病変を呈したStevens-Johnson 症候群例

Allopurinol Induced Stevens-Johnson Syndrome

Stevens-Johnson Syndrome (SJS) is an acute, self-limited, rare but life-threatening disease that manifests as severe mucocutaneous blistering and erosions. Here we report a rare case of allopurinol-induced SJS. A 25-year-old male patient with no other comorbidities was admitted to the hospital with complaints of fever, redness of eyes, swelling of lips with discharge and crusting, extensive erosions in the oral mucosa for the last 4 days, following consumption of allopurinol for a duration of 1 month. Investigations were within normal limits. The offending drug was withdrawn and he was treated with corticosteroids, antimicrobials, and other supportive measures. Allopurinol, a Xanthine oxidase inhibitor is mostly used for the treatment of primary and secondary hyperuricemia, Health care professionals must be aware of the spectrum of adverse effects of this drug and must take urgent measures once the diagnosis is suspected especially to save the patient from such severe or fatal reactions like SJS/Toxic epidermal necrolysis (TEN).

A case of Stevens-Johnson syndrome with a rash predominantly on the palms.

A case of Stevens-Johnson syndrome with a rash predominantly on the palms.

Single dose etanercept monotherapy for treating Stevens–Johnson syndrome

Stevens–Johnson syndrome (SJS) is a delayed type hypersensitivity reaction to drugs and less commonly infections. The entity represents one end of the spectrum of SJS-TEN (Toxic Epidermal Necrolysis) complex. Together, both conditions contribute to the majority of Severe Cutaneous Drug Reactions (SCARs) with high mortality and morbidity. Clinically, it presents with widespread painful erythematous macules, targetoid lesions, full-thickness or focal epidermal necrosis while mucosal involvement involves oral, genital, and ocular mucous membranes along with preceding prodromal flu like symptoms. While there is no consensus on the treatment of choice, systemic steroids, intravenous immunoglobulin and cyclosporin are most often employed for specific management of SJS-TEN. We report a case of SJS managed with a single dose of etanercept monotherapy.

DENTAL MANAGEMENT IN A CLINICAL CASE OF STEVENS-JOHNSON SYNDROME

This study aims to present findings and dental management in a clinical case of Stevens-Johnson Syndrome. Patient A. A. L., female, brown Skinned, 59 years old, was hospitalized for aneurysm clipping surgery. She was admitted to the intensive care unit after lowering the level of consciousness. During dental evaluation the patient presented generalized facial edema, maculopapular exanthema, and desquamative erythroderma. In the intraoral inspection multiple ulcerated lesions were observed with bleeding at the lowest stimulation in lips and oral mucosa. Laboratory tests revealed eosinophilia, thrombocytosis, and leukocytosis. Because of the clinical manifestations and the anatomopathologic report of the cutaneous biopsy, it was found to be Steven-Johnson syndrome. The treatment of oral lesions consisted of the removal of bloody crusts and laser therapy. After 15 days of laser therapy, there was a progressive clinical improvement of the lesions. The patient died, corroborating the high morbidity and mortality rates of the syndrome.

Severe skin toxicity with organ damage under the combination of targeted therapy following immunotherapy in metastatic melanoma.

Targeted therapy combination (TTC: antiRAF+antiMEK) is known to improve metastatic melanoma survival. Few severe skin toxicities (grade ≥3) are described with first-line TTC (17% for vemurafenib+cobimetinib and none for dabrafenib+trametinib) in a phase III trial. Among our 42 patients treated by TTC between January 2014 and March 2017, 4.8% (2/42) of those treated in the first line presented severe skin rash versus 19% (8/42) of patients treated in the second line after previous immunotherapy. In particular, we observed one case of Stevens-Johnson syndrome and four cases of severe drug reaction with eosinophilia and systemic symptoms syndrome under TTC in patients who had received immunotherapy previously. Thus, previous immunotherapy appears to play an important role in the skin rash onset and severity induced by TTC.

Phenytoin induced Stevens Johnson syndrome: a case report

Stevens-Johnson syndrome (SJS) is a rare consequence of hypersensitivity reaction precipitated by certain drugs and viral infections. It is an idiosyncratic drug reaction usually associated with drugs like anti-epileptics, non-steroidal anti-inflammatory compounds and antibiotics. The overall incidence of this entity is very low and is life-threatening if undiagnosed and untreated. The syndrome is characterized by purpuric macules and bullous eruptions involving the mucous membrane which may be followed by systemic manifestations. The mechanism of SJS due to drugs is not fully defined. Delayed Hypersensitivity reaction mediated by T lymphocytes in response to a drug is thought to be responsible. Here authors present a case of SJS induced by phenytoin in an adult male. The case warrants the need of adopting a meticulous approach while prescribing phenytoin. The case is being reported to accentuate the importance of adverse drug reactions and to emphasize the importance of reporting such reactions ensuring efficient pharmacovigilance.

A case report on phenobarbitone induced stevens-johnson syndrome: an alarming hypersensitivity reaction

Stevens-Johnson syndrome (SJS) is an Ig E mediated hypersensitivity reaction, sometimes complicated by ocular manifestations. Antiepileptics induced SJS is common with carbamazepine. Phenobarbitone is known to cause hypersensitivity reactions like mild to moderate rashes but not life-threatening reactions like SJS. We present a case report of an 18 years old female patient who presented with chief complaints of multiple, fluid-filled lesions associated with itching all over the body for 20 days and inability to open her eyes for 18 days. It had developed following ingestion of Tab. Phenobarbitone 30 mg orally BD for 15 days. She was diagnosed as a case of SJS and treated with parenteral followed by oral corticosteroids and antihistaminics and recovered over a span of 20 days. Causality was assessed as per WHO-UMC Causality Assessment criteria and Naranjo Scale. Main pathogenesis is apoptosis through an interaction between cell-surface death receptor like Fas and its receptive ligand or due to genetic deficiency. In case of aromatic anticonvulsants, cross reactivity is also suspected. Genetic studies and cross reactivity testing can help prevent further incidences in few.

Vancomycin-Induced Stevens-Johnson Syndrome in a Boy Under 2 Years Old: An Early Diagnosis by Granulysin Rapid Test

Stevens-Johnson syndrome (SJS) is a life-threatening disease, which is mainly ascribed to drugs, such as sulfonamides and psychoepileptics. In this article, we present a pediatric case of vancomycin-induced SJS and an alternative diagnostic algorithm. The patient presented with multiple target-like rashes and vesicles throughout the whole body after receiving vancomycin. Despite the fact that skin biopsy remains the gold standard for diagnosing SJS, the granulysin rapid test by immunochromatographic assay is a non-invasive option for children. In this article, we describe our use of the Algorithm of Drug causality for Epidermal Necrolysis and a modified T-cell activation assay for granzyme B and interferon gamma to screen for the culprit drug. Moreover, we applied the granulysin rapid test as an early diagnosis method for children with drug-induced SJS.

Phenytoin induced Stevens-Johnson syndrome: a case report

Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are rare but potentially life threatening cutaneous adverse drug reactions. Drugs commonly implicated are anti-microbials, anti-epileptics and non-steroidal anti-inflammatory drugs (NSAIDs). Amongst anti-epileptics, carbamazepine and phenytoin are the most common offending drugs. We report here a case of SJS due to phenytoin.