Stevens-Johnson Syndrome Research Articles

Thiotepa-Induced Toxicity: A Clinical Mimic of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Featuring Severe Mucositis, Diffuse Dusky Discoloration, and Skin Sloughing.

Thiotepa, an alkylating agent commonly used in chemotherapy, is increasingly recognized to induce cutaneous reactions resembling toxic erythema of chemotherapy (TEC). This condition is characterized by erythema, hyperpigmentation, and mucositis, often affecting intertriginous areas, and can mimic the early stages of Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). A 31-year-old woman with a history of systemic lupus erythematosus, antiphospholipid antibody syndrome, seizures, and chronic kidney disease was admitted for the management of central nervous system (CNS) lymphoma. Seven days after receiving thiotepa during an autologous stem cell transplant, she developed severe mucositis, requiring intubation for airway protection, followed by a dusky, gray, full-body rash with sloughing in the groin, axillae, and buttocks. A skin biopsy from the back revealed vacuolar interface changes, eccrine gland necrosis, and occasional necrotic keratinocytes at the dermal-epidermal junction, with no evidence of full-thickness necrosis or significant eosinophilic infiltration. The differential diagnosis included thiotepa-induced toxicity, SJS/TEN, and drug eruption. Based on the patient's clinical presentation and the biopsy findings, thiotepa-induced TEC was favored over SJS/TEN. Thiotepa is a potent lipophilic alkylating agent widely used in chemotherapy for pediatric and adult patients with various solid tumors and hematologic malignancies. Its anticancer mechanism involves DNA alkylation, leading to DNA strand cross-linking that disrupts replication and transcription, ultimately inhibiting cancer cell proliferation and survival. While thiotepa is primarily utilized in high-dose preparative regimens for stem cell transplantation in pediatric patients, its use in the adult population remains comparatively limited.This case emphasizes the importance of differentiating thiotepa-induced TEC from severe cutaneous adverse reactions such as SJS/TEN. While these conditions share clinical and histologic features, the absence of extensive epidermal necrosis, satellite cell necrosis, and systemic involvement, along with recent thiotepa exposure, supported a diagnosis of TEC. This case highlights the diagnostic challenge of distinguishing thiotepa-induced TEC from SJS/TEN in post-transplant patients. Recognizing the characteristic involvement of intertriginous areas and eccrine gland necrosis in TEC is critical for accurate diagnosis and management. Awareness of this potential complication in patients receiving thiotepa is essential to avoid misdiagnosis and inappropriate treatment.

Post-marketing safety of antiseizure medications: Focus on serious adverse effects including drug reaction with eosinophilia and systemic symptoms (DRESS).

On November 28, 2023, the U.S. FDA issued a Drug Safety Communication, warning that antiseizure medications (ASMs) levetiracetam and clobazam can cause a rare but serious reaction, drug reaction with eosinophilia and systemic symptoms (DRESS). However, the risk of DRESS from other ASMs remains unclear. This observational study examined post-marketing safety of ASMs focusing on serious adverse events (AEs) reporting including DRESS. This retrospective, cross-sectional study analyzed the U.S. FDA Adverse Event Reporting System (FAERS) data from January 1, 2004, to March 31, 2024. Ten older (valproic acid, carbamazepine, oxcarbazepine, phenytoin, and phenobarbital) and newer (zonisamide, topiramate, lamotrigine, lacosamide, and brivaracetam) frequently used ASMs and three benzodiazepines (lorazepam, chlordiazepoxide, and diazepam) in clinical practice as alternative treatments were examined together with levetiracetam and clobazam, respectively. Disproportionality analysis, reporting odds ratio (ROR), was used to detect reporting risk signals of DRESS along with serious AE, hospitalization, death, and Stevens-Johnson Syndrome (SJS) for levetiracetam/clobazam and alternative treatments. A statistically significant reporting risk signal was detected when the lower boundary of the 95 % confidence interval for the RORs exceeded 1. Levetiracetam had significant reporting risks of serious AE, hospitalization, DRESS, and SJS. Older ASMs including valproic acid, carbamazepine, oxcarbazepine, phenytoin, and phenobarbital all had significant reporting risks of DRESS and SJS. Newer ASMs including zonisamide and lamotrigine had significant reporting risks of DRESS and SJS, while topiramate, lacosamide, and brivaracetam did not exhibit reporting risk for DRESS. Clobazam had significant reporting risks of serious AE, DRESS, and SJS. Lorazepam, chlordiazepoxide, and diazepam did not exhibit reporting risks for DRESS or SJS. Findings highlighted reporting risk signals of DRESS for levetiracetam/clobazam and alternative ASMs. Given the limitations from passive surveillance nature of FAERS, further surveillance and longitudinal studies are essential to evaluate and confirm our findings.

Vancomycin and linezolid: severe cutaneous adverse reactions to drugs

ABSTRACT Background Severe cutaneous adverse reactions (SCARs), including Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN), Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), and Acute Generalized Exanthematous Pustulosis (AGEP), pose significant therapeutic challenges. Vancomycin and linezolid have been linked to these life-threatening conditions, necessitating a better understanding of their associated risks. Methods We conducted a retrospective analysis using data from the FDA Adverse Event Reporting System (FAERS) database. Disproportionality and Bayesian statistical analyses were applied to evaluate the associations between vancomycin, linezolid, and SCARs, comparing the outcomes induced by these drugs. Results Of the 11,737,133 data, there were a total of 1024 vancomycin-associated SCARs and 125 cases of linezolid-associated SCARs. Vancomycin was strongly associated with DRESS, showing a Reporting Odds Ratio (ROR) of 53.79 (95% CI: 49.75–58.16), Proportional Reporting Ratio (PRR) of 50.38, and Empirical Bayesian Geometric Mean (EBGM) of 2.32. For SJS and TEN, vancomycin reported RORs of 8.04 and 15.63, respectively. Linezolid demonstrated lower associations, with RORs of 5.14 for DRESS and 2.36 for SJS. Conclusions Vancomycin presents a higher risk of SCARs compared to linezolid, particularly for DRESS. Underscoring the need for cautious use and the potential benefit of personalized medicine practices to improve patient safety.

Posterior Lamellar Augmentation With Auricular Cartilage Grafting for Severe Cicatricial Entropion Correction in Cicatricial Ocular Surface Disease.

Description of clinical profile, surgical technique, and outcomes in patients having severe entropion secondary to cicatricial ocular surface disorders, who underwent entropion repair and posterior lamellar augmentation using auricular cartilage graft. A retrospective review of electronic medical records was performed over a 4-year period (August 2019-August 2023) to identify cases with entropion and cicatrizing ocular surface disorders that had undergone entropion repair with auricular cartilage grafting. Seventeen eyelids of 15 patients were included. The average age of the study population was 33.17 ± 16.8 years, with an almost equal male to female ratio (8 male, 7 females). Lower eyelid was more commonly involved (n = 11, 64.7%) than the upper eyelid (n = 6). Steven-Johnson syndrome (n = 11, 64.7%) was the most frequent etiology. Two patients (13.3%) underwent bilateral surgical repair, whereas in 5 eyelids (29.4%), the procedure was combined with lid margin mucous membrane grafting at the same sitting. Cartilage graft was harvested through posterior auricular approach in all cases. Postoperatively, entropion correction was achieved in 16 eyelids (94.1%), and postoperative improvement in ocular surface scoring was noted in 11 eyelids (64.7%). Improvement in visual acuity postoperatively was noted in 52.9% eyes. Over an average follow-up of 16.64 months, 1 eyelid (5.8%) required additional everting sutures and 1 eyelid (5.8%) needed trimming of the graft. Cartilage graft-aided entropion surgery is a viable and satisfactory management option in severe cicatricial entropion in ocular surface disorders and can be combined with lid margin mucous membrane grafting for simultaneous correction of lid margin keratinization. Auricular cartilage is a versatile graft with easy harvesting and minimal donor-site morbidity.

Stevens-Johnson Syndrome and Erythema Multiforme Induced by Imiquimod 5% Cream

Introduction: Topical imiquimod is a safe and effective treatment for actinic keratoses, superficial basal cell carcinomas and anogenital warts. The treatment is commonly associated with local inflammatory reactions, while systemic side effects are rare and generally mild. Only few cases of erythema multiforme and Stevens-Johnson syndrome have been described in association with topical imiquimod application. Objective: We present a review of the existing cases of erythema multiforme and Stevens-Johnson syndrome reported in the literature, analyzing the clinical appearance, the histology and the treatment of the lesions. Method: Nine case of erythema multiforme were reported, characterized by cutaneous rash, bullae, crusting, erosive and targetoid lesions, mainly located at the extremities. Mucosal involvement and systemic symptoms were sometimes present. Results: Three cases of Stevens-Johnson syndrome were associated with topical imiquimod. In all cases, the authors reported targetoid lesions and areas of erosion affecting trunk and limbs, associated with systemic symptoms, and, in 2 cases, to mucosal erosions. Conclusions: We hypothesize a possible role of interferon-γ, a cytokine involved in the pathogenesis of both herpes-associated erythema multiforme and Stevens-Johnson syndrome, which is released in response to the administration of imiquimod.

The Potential Roles of IL-1β, IL-6, and RIPK3 in the Pathogenesis of Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis

Background/Objectives: Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis (SJS/TEN) are rare but severe skin conditions, often triggered by medications, that can be life-threatening. These conditions frequently affect the eyes, causing ocular surface disease, which can result in visual impairment or blindness. Although the exact mechanisms behind SJS/TEN remain unclear, key inflammatory mediators such as IL-1β, IL-6, and RIPK3 are believed to play critical roles in inflammation, necroptosis, and regulatory processes. Investigating these factors offers new insights into the disease’s underlying mechanisms and potential targets for treatment. This study aims to determine the roles of IL-1β, IL-6, and RIPK3 in the pathogenesis of SJS/TEN. Methods: The study examined the expression levels of IL-1β, IL-6, and RIPK3 in skin biopsies from patients with biopsy-confirmed SJS/TEN, using lichen planus as a positive control and normal skin as a baseline control. Immunohistochemistry was employed for this analysis. Additionally, the impact of SJS/TEN patient plasma on mitochondrial function was assessed in platelets and human corneal epithelial (H-CET) cells. Using a fluorescent plate reader, mitochondrial activity and superoxide ion levels were measured, comparing plasma from SJS/TEN patients to normal human plasma. Results: Skin biopsies from SJS/TEN patients showed a significantly higher expression of IL-1β, IL-6, and RIPK3 compared to both lichen planus and normal controls. Furthermore, plasma from SJS/TEN patients significantly reduced platelet viability and increased mitochondrial and total cellular superoxide ions, as demonstrated by elevated levels of MitoSOX Red and CellROX Red. Conclusions: These findings suggest that IL-1β, IL-6, and RIPK3 may contribute to the pathogenesis of SJS/TEN and highlight their potential as targets for therapeutic intervention.

SYNDROME OF BURNED SKIN IMPROVEMENTS IN TREATMENT AND DIAGNOSIS

Background: Staphylococcus aureus produces epidermolytic toxins that disrupt epidermal cell connections, resulting in staphylococcal scalded skin syndrome (SSSS). Blisters, erythematous cellulitis, and superficial skin peeling characterize this condition. Objective: To provide an overview of the clinical foundation, etiopathogenesis, complications, current treatment options, and potential future advancements in managing SSSS. Methods: This review synthesizes available data on the pathogenesis, clinical manifestations, differential diagnoses, and therapeutic interventions for SSSS. Results: It is classified as a toxin-mediated infection, primarily affecting adults and pediatric patients. Key therapeutic interventions include: Wound care to protect damaged skin. Antibiotic therapy with antistaphylococcal medications. Supportive care with analgesia. Differential diagnoses such as toxic epidermal necrolysis, adverse drug reactions, and Stevens-Johnson syndrome require multidisciplinary evaluation by dermatologists, infectious disease specialists, and surgeons. Conclusion: Effective management of SSSS involves a multidisciplinary approach to reduce mortality. Future developments may enhance understanding and treatment outcomes for this toxin-mediated disease.

Exosomal miR-375-3p mediated lipid metabolism, ferritinophagy and CoQ-dependent pathway contributes to the ferroptosis of keratinocyte in SJS/TEN.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) manifest life-threatening cutaneous adverse drug reactions characterized by keratinocyte death. Previous studies have indicated that apoptosis and necroptosis are implicated in SJS/TEN pathogeneses. However, other forms of cell death involved in this process remain unidentified. Ferroptosis, cell death driven by iron-dependent lipid peroxidation, has been implicated in various human diseases. In this study, the identification of ferroptosis and the potential effects of ferroptosis on SJS/TEN were investigated. We demonstrated that the skin lesions and plasma of SJS/TEN patients show increased levels of lipid peroxidation and iron. The biomarkers of ferroptosis correlated positively with the disease severity in SJS/TEN patients. Besides, plasma exosomes derived from patients with SJS/TEN exhibited elevated levels of cellular oxidized polyunsaturated fatty acids (PUFAs) and phospholipids phosphatidylethanolamine (PE), the key phospholipids that drive cells towards ferroptotic death. miR-375-3p, enriched in plasma-derived exosomes from SJS/TEN patients, was observed reduce both ferritin heavy chain 1 (FTH1) and ferroptosis suppressor protein 1 (FSP1) expression. Parallelly, exosomal miR-375-3p overexpression increased the level of lipid peroxidation but decreased the coenzyme Q10 (CoQ10), thus enhancing the ferroptosis rate of keratinocyte. Above all, we concluded that ferritinophagy-mediated ferroptosis, lipid metabolism, and the FSP1-CoQ-dependent pathway in ferroptosis are critical mechanisms contributing to SJS/TEN. Targeting ferroptosis in keratinocyte may be a therapeutic strategy for preventing SJS/TEN in the future.

Delayed Stevens-Johnson syndrome induced by combined administration of carbamazepine and botulinum toxin: A case report.

Steven-Johnson syndrome (SJS) is characterized by severe illness, rapid progression, and high mortality rates, with the vast majority of cases induced by medications. Botulinum toxin, a neurotoxin produced by Clostridium botulinum, has not been reported in the literature as a causative agent of SJS. A 56-year-old male patient, who underwent surgery for cerebral hemorrhage, developed widespread patchy annular papules following the injection of botulinum toxin into the masseter muscle. Some lesions exhibited a target-like appearance, and all major organ systems were affected. Consider the delayed SJS induced by the combination of carbamazepine and botulinum toxin. Intravenous administration of methylprednisolone in conjunction with immunoglobulin is indicated. For ocular lesions, topical treatment includes tobramycin-dexamethasone and sodium hyaluronate eye drops; for ulcerated areas, local application of lactulose-iodoquinol is recommended, while non-ulcerated regions should be treated with halometasone ointment topically. The patient has been discharged, and there has been a noticeable improvement in their symptoms. In order to prevent severe adverse reactions, patients using carbamazepine in conjunction with other medications should be vigilant for the early symptoms of serious drug rashes.

Intense Pulsed Light in the Treatment of Dry Eye and Meibomian Gland Dysfunction in Patients With Chronic Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis.

To evaluate the efficacy and safety of intense pulsed light (IPL) combined with meibomian gland expression (MGX) for the treatment of dry eye disease and meibomian gland dysfunction associated with chronic Stevens-Johnson syndrome and toxic epidermal necrolysis. This prospective noncomparative interventional study included 29 patients (58 eyes) who underwent 3 sessions of IPL and MGX at 2-week intervals. Subjective symptoms (ocular surface disease index score) and objective dry eye tests: matrix metalloproteinase 9, tear meniscus height, bulbar redness score, tear film lipid layer thickness (LLT), Schirmer I test, conjunctival and corneal staining, meibomian gland loss, MGX score [meibomian gland score (MGS)], and tear break-up time were assessed at the baseline and after 4, 8, and 12 weeks. Twenty-nine individuals (57 eyes) were included in this analysis. The ocular surface disease index score decreased significantly from 60.07 ± 23.34 (baseline) to 38.36 ± 22.39 (after 90 days) (P < 0.01). The fluorescein and lissamine green staining scores, MGS, and LLT improved significantly (P < 0.01). In contrast, there were no significant changes in the tear meniscus height values, matrix metalloproteinase 9 positivity, bulbar redness score, Schirmer test, meibography of the superior and inferior eyelids, and tear break-up time. Ocular or skin complications were not observed. Three IPL therapy sessions followed by MGX seemed to be safe and effective in treating dry eye disease and meibomian gland dysfunction, improving vision-related quality of life, dry eye symptoms, and ocular surface signs, such as corneal and conjunctival staining scores, MGS, and LLT after 90 days in patients with chronic Stevens-Johnson syndrome and toxic epidermal necrolysis.

Epidemiological Characteristics and Prognostic Scoring in Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome: Insights from a 17-Year Burn Center Experience.

Background and Objectives: Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are rare yet life-threatening dermatologic conditions characterized by severe skin and mucous membrane involvement. Accurate prognostic systems are crucial for clinical management to assess disease severity and predict outcomes. The primary objective of this study was to assess the epidemiological characteristics and clinical outcomes of patients with Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap over a 17-year period at a specialized burn center. The secondary objectives were to evaluate the performance of existing prognostic scoring systems (SCORTEN, Re-SCORTEN, and ABCD-10) in predicting mortality and to propose a novel classification tree model to improve mortality prediction. Materials and Methods: A 17-year retrospective study at a burn center included 68 patients with SJS, SJS/TEN overlap, or TEN. Demographic, clinical, laboratory data, and prognostic scores (SCORTEN, Re-SCORTEN, ABCD-10) were collected and analyzed for associations with mortality. A classification tree was created to detect unknown determinants of SJS/TEN mortality. Results: The drug most frequently associated with the occurrence of SJS/TEN was metamizole. The mortality rate was 51%. Affected body surface area, platelet count, and serum blood urea nitrogen differed significantly between survivors and non-survivors. Regarding the scoring systems, only the Re-SCORTEN showed reliable differentiation for these groups. A classification tree model achieved an accuracy of 89% in predicting the mortality risk. In the ROC curve analysis, the AUC values were 0.88 for the classification tree, 0.66 for Re-SCORTEN, 0.61 for SCORTEN, and 0.56 for ABCD-10. Conclusions: This study explores mortality predictors in SJS/TEN via a classification tree model, highlighting potential factors for further investigation. While cautioning against immediate clinical application due to data constraints, the findings underscore the need for larger studies to validate and refine prediction models in this context.

Pharmacogenomics predictors of aromatic antiepileptic drugs-induced SCARs in the Iraqi patients.

Severe cutaneous adverse reactions (SCARs) are life-threatening and often linked to antiepileptic drugs (AEDs). Common types of SCARs include Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS). Immune-mediated mechanisms involving human leukocyte antigen (HLA) alleles have been implicated in the pathogenesis of this reaction. This study examines the association between specific HLA alleles (HLA-A, -B, and -DRB1) and AED-induced SCARs in the Iraqi population. A total of 50 patients diagnosed with SCARs and 90 tolerant controls were recruited from Dr. Saad Al-Wattari Hospital for Neurological Sciences and Baghdad Hospital - Medical City. HLA genotyping was performed using PCR-SSO method from peripheral blood samples. Statistical comparisons were made using the t-test or chi-square test, while univariate logistic regression with Bonferroni's correction (p<0.05) were used to assess associations between HLA alleles and SCARs. Among the patients, SJS was the most prevalent type of SCARs observed. Analysis of HLA allele frequencies revealed significant associations between specific alleles. HLA-A∗02:01 was found to be significantly associated with a lower risk of AED-induced SJS (OR=0.36; 95% CI: 0.13-0.97), while HLA-A∗24:02 and HLA-B∗15:02 were associated with an increased risk of AED-induced SJS (OR=3.60; 95% CI: 1.21-10.72 and OR=4.41; 95% CI: 1.18-16.47, respectively). For AED-induced TEN, HLA-A∗01:02, HLA-B∗15:02, and HLA-B∗52:01 showed significant associations (OR=6.92; 95% CI: 1.39-34.37 and OR=6.55; 95% CI: 1.62-26.52, respectively), with HLA-DRB1∗03:01 being highly significant (OR=5.09; 95% CI: 1.72-15.00). Additionally, HLA-B∗40:02 was strongly associated with AED-induced DRESS (OR=29.33; 95% CI: 3.50-245.32). This study identifies key HLA alleles associated with AED-induced SCARs in the Iraqi population. These findings could facilitate personalized medicine approaches, aiding in better prediction and prevention of SCARs in AED therapy.

Impact of a novel limbal-rigid contact lens on potential cost savings in Stevens-Johnson syndrome patients from postmarket surveillance

Impact of a novel limbal-rigid contact lens on potential cost savings in Stevens-Johnson syndrome patients from postmarket surveillance

Biologics to the Rescue in Case of Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis

Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are serious adverse drug reactions, triggered by medications, infections, malignancies and idiopathic causes. Clinically, they manifest as widespread, painful erythematous macules and target-like lesions, often accompanied by full-thickness or localised epidermal necrosis. Our patient, a 33-year-old male, presented with oral ulcers and painful red lesions starting from the face and progressing to involve trunk and upper extremities 5 days after administration of intravenous diclofenac for severe headache. Additional symptoms included ulceration over lips and buccal mucosa. He was diagnosed clinically as a case of SJS-TEN overlap with Severity of illness score for toxic epidermal necrolysis (SCORTEN) of 3 and was given intravenous corticosteroids. Here, we report a case of SJS-TEN overlap with corticosteroids-induced acute psychosis, treated successfully with etanercept monotherapy.

Stevens-Johnson syndrome due to Methotrexate: a case report

Stevens-Johnson syndrome due to Methotrexate: a case report

HLA B*15:02 and carbamazepine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis: first case report from Nepal with genetic analysis

Introduction and importance: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the severe adverse drug reactions following drugs like carbamazepine, allopurinol, and infections. Here we present A 32-year-old woman developed SJS/TEN after 7 days of carbamazepine therapy, highlighting the importance of recognizing this risk, particularly in HLA-B*1502 allele carriers. Case presentation: A 32-year-old female developed fever, vomiting, and mucocutaneous blisters 7 days after starting carbamazepine. Lesions spread from the face to the chest, abdomen, and extremities, with throat discomfort and eye discharge. History included prior dizziness episodes. Examination revealed denuded skin, positive Nikolsky’s sign, and HLA-B*1502 allele positivity. Treatment comprised ceasing carbamazepine, fluid administration, and steroids. Discussion: SJS/TEN manifest with distinct symptoms and often emerge within weeks of drug exposure. Carbamazepine, a frequent trigger, poses higher risks for HLA-B1502 allele carriers. Timely identification and intervention are essential to reduce mortality rates (10-40%). Treatment involves corticosteroids and supportive measures, with pre-carbamazepine HLA-B1502 screening advised, despite potential accessibility constraints. Conclusion: This case underscores the necessity of recognizing carbamazepine-induced SJS/TEN risk, particularly in HLA-B*1502 carriers. Despite screening challenges, early intervention involving multidisciplinary specialists is essential for favorable outcomes. Increased awareness and proactive measures are vital in preventing and managing these severe reactions.

Stevens-Johnson syndrome/TEN induced by lamotrigine in a patient with a cerebral cavernous malformation: a case report

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but serious cutaneous reactions characterized by epidermal and mucocutaneous detachment, most often drug-induced. SJS and TEN are considered the opposite extremes of the same spectrum of disease, where the percentage of skin involvement is &lt;10% in SJS and &gt;30% in TEN; the in-between range is called a SJS/TEN overlap. We present the case of a 64-year-old patient who was treated with lamotrigine, an anti-epileptic drug, and developed SJS/TEN. After being hospitalized and recovering for three days due to the worsening of the clinical presentation, he was transferred to a burn center. Making an early diagnosis and identifying the indicated drug is extremely important to set the appropriate treatment and reduce mortality. Advanced supportive care is required.

Cutaneous Adverse Drug Reactions to Antiseizure Medications

Discontinuation of antiseizure medications (ASMs), primarily prompted by adverse effects, presents a formidable challenge in the management of epilepsy, and impacting up to 25% of patients. This article thoroughly explores the clinical spectrum of cutaneous adverse drug reactions (cADRs) associated with commonly prescribed ASMs. Ranging from mild maculopapular rashes to life-threatening conditions such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), the diverse manifestations are meticulously detailed. Diagnostic strategies, incorporating red flags and testing methodologies, are elucidated to ensure precise identification. The classification of adverse drug reactions (ADRs), with a specific focus on cADRs and their association with type A or type B reactions, is presented. Critical risk factors, encompassing patient demographics, drug-related skin reactions, and genetic predispositions, are thoroughly explored. The article underscores the role of human leucocyte antigen (HLA), including HLA*15:02, in predicting susceptibility to severe reactions like SJS/TEN, particularly with aromatic ASMs prevalent in specific populations. Management strategies for varying cADR severities are discussed, placing emphasis on drug discontinuation, symptomatic relief, and potential desensitization. The article concludes by consolidating current knowledge, providing clinicians with a roadmap for navigating the complexities of diagnosis and management. The integration of personalized medicine principles and evidence-based approaches emerges as a crucial paradigm for the future of epilepsy management, aiming to minimize the impact of ADRs on patient outcomes.

Acyclovir Induced Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis - A Rare Case Report

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis are serious, life-threatening conditions often triggered by drug reactions, characterized by widespread skin detachment and mucosal involvement. This case report describes a 29-year-old woman who developed Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis after receiving prophylactic acyclovir for suspected herpes. The patient initially presented with oral ulcers that rapidly progressed to widespread blisters, ulcers, and severe skin peeling. A thorough diagnostic evaluation, including skin biopsy and the Naranjo algorithm, identified acyclovir as the causative agent. The patient was managed in intensive care with intravenous methylprednisolone 500mg per day for 3 consecutive days as pulse therapy, antibiotics, and other supportive treatments. This case underscores the importance of early recognition, prompt discontinuation of the offending drug, and a multidisciplinary treatment approach. It also highlights the critical need for heightened awareness among healthcare professionals regarding the potential for severe adverse reactions with commonly used medications like acyclovir, to improve patient safety and outcomes.

Stevens-Johnson Syndrome secondary to nivolumab in a patient with mixed cell variety classical Hodgkin Lymphoma

The immune checkpoint inhibitors (ICIs) nivolumab and pembrolizumab are some of the principal treatment options for relapsed or refractory classic Hodgkin lymphoma. However, immunotherapy has been related to dermatological adverse events (DAEs) and could lead to discontinuation of cancer treatment in severe cases. DAEs encompass entities such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), SJS/TEN-like reactions, drug reaction with eosinophilia and systemic symptoms (DRESS). We reported a case of a 46-year-old- female with classic mixed cellularity Hodgkin lymphoma, Lugano IV, who underwent a hematopoietic cell transplant and subsequent relapse, currently with Stevens-Johnson Syndrome secondary to nivolumab.