Drug-related Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Review

Abstract

A bstract Introduction Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, life-threatening, allergic reactions affecting the skin and mucous membranes. SJS is considered to be a milder form with less than 10% of body surface area (BSA) involvement. We report successful management of two cases of SJS and TEN. Firstly, a case of a 24-year-old female who presented with rashes over face, chest, and upper limbs after the oral intake of ciprofloxacin and local application of moxifloxacin eye drops. She developed high-grade fever and difficulty in breathing requiring intubation and lung-protective mechanical ventilation and was treated with high-dose methylprednisolone, azithromycin, soframycin skin dressings, and topical ocular antibiotics. Secondly, another case of a 16-year-old female who developed bullous eruptions over the trunk, arms, hands, face, and sole involving 60% of BSA, after oral intake of albendazole. She was diagnosed as TEN and successfully managed with sterile silver nitrate, soframycin dressings, and antibiotics. Key message Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening, allergic reactions affecting the skin and mucous membranes. Early identification, withdrawal of the suspected drug, and early transfer to a specialized center decrease mortality. How to cite this article Arora R, Pande RK, Panwar S, Gupta V. Drug-related Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Review. Indian J Crit Care Med 2021;25(5):575–579.

Weeding Out the Culprit: Cannabinoid-Associated Stevens-Johnson Syndrome

“…SJS and toxic epidermal necrolysis (TEN) are severe cutaneous eruptions that are characterized by disruption of the epidermal-dermal junction leading to severe skin sloughing [ 1 ]. The etiology of these syndromes is most frequently related to the use of medications including sulfa derivatives, nonsteroidal anti-inflammatory medications, penicillin-based antibiotics, tetracyclines, cephalosporins, antiepileptics, barbiturates, and recreational drugs [ 2 ].…”

“…Multidisciplinary consultations including dermatology and ophthalmology are also important aspects of care. There exists conflicting literature and recommendations surrounding other adjunctive therapies, including systemic corticosteroids, intravenous immunoglobulin (IVIG), tumor necrosis factor-alpha (TNF-α) inhibitors, and cyclosporine, for the treatment of SJS/TEN [ 1 , 4 ].…”

“…Stevens-Johnson syndrome (SJS) is a hypersensitivity reaction that most commonly manifests as a severe skin reaction caused by medication usage that can occur alongside systemic symptoms [ 1 ]. This type of reaction is often triggered by medication usage but can also be secondary to an infection, though in many cases no clear etiology can be identified [ 2 , 3 ].…”

A Compilation of Drug Etiologies of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

“…Albendazole: Albendazole is an antiparasitic drug that can treat hydatid disease and other infections caused by tapeworms. A case report details albendazole causing TEN in a 16-year-old female [ 102 ].…”

Current understanding of genetic associations with delayed hypersensitivity reactions induced by antibiotics and anti-osteoporotic drugs

“…SJS and TEN are rare but life-threating dermatologic diseases and represented as T cell-mediated keratinocyte death ( Arora et al, 2021 ). TEN is always triggered by drugs, while SJS almost triggered by drug and small part of infection ( Nowsheen et al, 2021 ).…”