A rare case of oxcarbazepine induced Stevens Johnson Syndrome: toxic epidermal necrosis overlap

Maitra, Aditi; Bhattacharyya, Shashwat; Mukherjee, Shatavisa; Era, Nikhil

doi:10.18203/2319-2003.ijbcp20170350

Cited by 6 publications

(7 citation statements)

References 6 publications

(8 reference statements)

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“…In the present case, the child was started on phenobarbitone, one of the common culprit drug associated with TEN [15,18]. Likewise, other antiepileptic drugs (AED) were also incriminated with this deadly hypersensitivity skin reaction; few of these AEDs include: phenytoin, carbamazepine, oxcarbazepine, and lamotrigine [4,16,19,20]. Therefore, clinicians should be aware of these drugs which are highly associated with TEN and should replace with drugs associated with lower skin hypersensitivity reactions.…”

Section: Discussionmentioning

confidence: 92%

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Toxic epidermal necrosis associated with phenobarbitone: a case report and brief review of the literatures

Ayele

Ali

Mulatu

2021

Allergy Asthma Clin Immunol

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Background Toxic epidermal necrolysis (TEN)/Stevens–Johnson syndrome (SJS) is the spectrum of severe, acute, mucocutaneous, T-cell mediated delayed type IV hypersensitivity reaction and universally related to different drugs. Phenobarbitone is known to cause hypersensitivity reactions with benign pattern; ranging from a mild to moderate rashes but not life-threatening reactions such as TEN/SJS. Case report We report a 14-year-old asthmatic male patient admitted to a local hospital for an acute exacerbation of asthma, after he presented with shortness of breath, cough, and fever. He was treated with bronchodilator and antibiotics. On subsequent days, the patient developed new onset generalized tonic clonic seizure in the hospital for which he was started on phenobarbitone of 100 mg twice daily. Two weeks after initiation of phenobarbitone, the patient developed extensive blistering skin eruptions; which subsequently exfoliated unevenly. Associated with the hypersensitivity skin reaction, the patient reported low grade fever, sore throat, and dysphagia. The exfoliation also involved oral and conjunctival mucosa; with estimated 65% body surface area involvement. The laboratory investigations were relevant for mild leucocytosis, prolonged prothrombin time, and reduced albumin. Phenobarbitone was discontinued and replaced with clonazepam; and the patient was managed with fluids replacement, IV antibiotics, twice daily wound care, analgesics, and naso gastric tube feeding. On subsequent days the patients’ clinical condition started improving; the skin lesion also started to heal and exfoliate in most of the affected skin surface areas, and the patient was discharged improved after ten days of intensive care unit. Conclusion In summary, the present case describes, a 14-years-old young child with history of asthma and seizure disorder; and developed toxic epidermal necrosis following exposure to Phenobarbitone. This case also highlighted the better prognosis observed in pediatric population with TEN.

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Section: Discussionmentioning

confidence: 92%

“…Toxic epidermal necrosis is associated with drug exposure in up to 90% of the cases. These drugs includes: anticonvulsants, antibiotics, allopurinol, and nonsteroidal anti-inflammatory [3,4,7,[16][17][18]. In the present case, the child was started on phenobarbitone, one of the common culprit drug associated with TEN [15,18].…”

Section: Discussionmentioning

confidence: 93%

Toxic epidermal necrosis associated with phenobarbitone: a case report and brief review of the literatures

Ayele

Ali

Mulatu

2021

Allergy Asthma Clin Immunol

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“…Few of these AEDs include phenytoin, carbamazepine, and lamotrigine. 7 Therefore, clinicians should be aware of these drugs which are highly associated with SJS-TEN and should replace with drugs associated with lower skin hypersensitivity reactions. Skin and liver are the most affected organs by TEN.…”

Section: Discussionmentioning

confidence: 99%

A case of phenobarbitone induced Stevens-Johnson syndrome-toxic epidermal necrolysis along with its causality assessment

Singh

Rani²,

Shankar³

et al. 2022

Int J Basic Clin Pharmacol

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Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse drug reaction, which are mainly caused by drugs; and these are usually associated with high degree of morbidity and mortality. They are characterized by mucocutaneous tenderness and typically haemorrhagic erosions, erythema and more or less severe epidermal detachment as blisters and areas of denuded skin. High risk drugs for the development of SJS-TEN include phenobarbitone, phenytoin, carbamazepine, lamotrigine, nevirapine, NSAIDs, allopurinol, and cotrimoxazole. A 33 years old female patient came to skin and venereal diseases (VD) outpatient department (OPD) with complaints of painful skin lesions. She was apparently symptom free 15 days back. Then she took tablet phenobarbitone 60 mg, BD as her anti-epileptic treatment. After 12-13 days of taking the drug, she developed erythematous papules associated with itching over her both forearm, face, chest, abdomen, back and lower limbs bilaterally which rapidly progressed to fluid-filled blisters that ruptured to form painful erosions and desquamation of skin all over the body. The patient was managed by withdrawal of phenobarbitone and conservatively, and the patient recovered successfully. The causality of phenobarbitone in this reaction was “probable” as per Naranjo scale. Seriousness of the reaction was “prolonged hospitalization”. Phenobarbitone is one of the most common causative agents of SJS and TEN. The main stay of treatment is immediate withdrawal of causative agent along with supportive care.

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“…anticonvulsants, antibiotics, allopurinol, and non-steroidal anti-in ammatory (3,4,7,(12)(13)(14). In the present case, the child was started on Phenobarbitone, one of the common culprit drug associated with TEN (11,14).…”

Section: Case Reportmentioning

confidence: 99%

“…In the present case, the child was started on Phenobarbitone, one of the common culprit drug associated with TEN (11,14). Likewise, other antiepileptic drugs (AED) were also incriminated with this deadly hypersensitivity skin reaction; few of these AEDs include: phenytoin, carbamazepine, Oxcarbazepine, and Lamotrigine (4,12,15,16). Therefore, clinicians should be aware of these drugs which are highly associated with TEN and should replace with drugs associated with lower skin hypersensitivity reactions.…”

Section: Case Reportmentioning

confidence: 99%

Phenobarbitone Induced Toxic Epidermal Necrosis in a Young Patient - A Rare Clinical Presentation: A Case Report and Brief Review of the Literatures

Ayele

Ali

Mulatu

2021

Preprint

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Background: Toxic epidermal necrolysis (TEN)/ Stevens-Johnson syndrome (SJS) is the spectrum of severe, acute, mucocutaneous, Ig E mediated hypersensitivity reaction; universally related to different drugs. Phenobarbitone is known to cause hypersensitivity reactions with benign pattern; ranging from a mild to moderate rashes but not life-threatening reactions such as TEN/SJS. Little is known about TEN in asthmatic patient. To the best of our knowledge, this is the first case of Phenobarbitone-induced TEN in a young asthmatic patient from the sub Saharan African. Case report: We report a 14-year-old right handed asthmatic male patient who presented with extensive blister skin eruptions involving the whole body including mouth ear canal later followed by skin exfoliation associated with low grade fever, sore throat, and dysphagia. The hypersensitivity skin reaction developed two weeks after initiation of Phenobarbitone of 100mg twice daily for a new onset generalized tonic clonic seizure. The exfoliation also involved oral and Conjunctival mucosa; with estimated 65% body surface area involvement; hence the diagnosis of Toxic epidermal necrosis was made. The Laboratory investigations were relevant for mild leucocytosis, prolonged prothrombin time, and reduced albumin. Phenobarbitone was discontinued and replaced with clonazepam; and the patient was managed with fluids replacement, IV antibiotics, twice daily wound care, analgesics, and naso gastric tube feeding. On subsequent days in intensive care unit (ICU), the patients’ clinical condition started improving; the skin lesion also started to heal and exfoliate in most of the affected skin surface areas, and the patient was discharges improved after ten days of ICU care.Conclusion: In summary, the present case describes, a 14-years-old young child with history of allergy in a form of asthma and new onset seizure disorder; and developed toxic epidermal necrosis following exposure to Phenobarbitone. This case also highlighted the benign prognosis observed in paediatrics population with TEN.

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A rare case of oxcarbazepine induced Stevens Johnson Syndrome: toxic epidermal necrosis overlap

Cited by 6 publications

References 6 publications

Toxic epidermal necrosis associated with phenobarbitone: a case report and brief review of the literatures

Toxic epidermal necrosis associated with phenobarbitone: a case report and brief review of the literatures

A case of phenobarbitone induced Stevens-Johnson syndrome-toxic epidermal necrolysis along with its causality assessment

Phenobarbitone Induced Toxic Epidermal Necrosis in a Young Patient - A Rare Clinical Presentation: A Case Report and Brief Review of the Literatures

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