Early high-dose intravenous corticosteroids rapidly arrest Stevens Johnson syndrome and drug reaction with eosinophilia and systemic symptoms recurrence on drug re-exposure

Lehloenya, Rannakoe; Isaacs, Thuraya; Nyika, Tonderai; Dhana, Ashar; Knight, Lauren; Veenstra, Simon; Peter, Jonny

doi:10.1016/j.jaip.2020.08.012

Cited by 23 publications

(11 citation statements)

References 8 publications

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“…Drug challenges are generally contraindicated in patients with DRESS as it could potentially lead to lethal recurrence of disease. However, if there is no effective alternative treatment available, a drug could potentially be re-introduced in a hospital setting that allows for prompt identification of recurrence and intervention with systemic immunosuppression in case of a reaction [60]. Patients should be educated on meticulous avoidance of the offending drug and cross-reacting drugs.…”

Section: Identifying Culprit Drugmentioning

confidence: 99%

Updates and Insights in the Diagnosis and Management of DRESS Syndrome

Schunkert

Divito

2021

Curr Derm Rep

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Section: Identifying Culprit Drugmentioning

confidence: 99%

Updates and Insights in the Diagnosis and Management of DRESS Syndrome

Schunkert

Divito

2021

Curr Derm Rep

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“…There is no standard treatment regimen for SJS[ 26 ], and multidisciplinary care, best supportive care, and corticosteroids are currently the most important components of its therapy[ 20 ]. By applying high-dose corticosteroids early, we can rapidly arrest SJS, while the optimal cutoff time of corticosteroids remains controversial because of its adverse drug reaction[ 27 ]. From the author’s perspective, the appropriate duration of high-dose corticosteroids is within 4 wk.…”

Section: Discussionmentioning

confidence: 99%

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

Wu¹,

Kang²,

Yi³

et al. 2022

WJCC

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BACKGROUND For 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 SUMMARY We 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. CONCLUSION We believe our report can provide some references for the treatment of SJS and the treatment of immune-related adverse reactions.

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“…A recent study has shown the ability of high-dose intravenous corticosteroids to reverse the recurrence of symptoms during DPT in patients with SJS and DRESS syndrome, potentially improving the safety of drug rechallenge protocols in these patients. 15…”

Section: Discussionmentioning

confidence: 99%

Drug reexposure in children with severe mucocutaneous reactions

Moral

Toral

Gilabert

et al. 2022

aei

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In pediatric patients, severe cutaneous adverse reactions (SCARs) frequently occur in the course of acute illnesses, mostly infections, which are usually treated with antibiotics or analgesics. The drug provocation test (DPT) is contraindicated in such situations, due to the risk of triggering a new severe reaction. As a consequence, lifelong avoidance is recommended. However, causation is uncertain in most cases. The dilemma arises when avoiding the drug is not harmless for the patient. We have attended three patients who were referred to our pediatric allergy unit with a history of SCAR related in time to simultaneous use of paracetamol and ibuprofen. Medical records and images of the patients were reviewed with the assistance of a dermatologist, and alternative diagnoses were considered in both cases. The ALDEN score for implicated drugs was calculated. After considering a high probability of ibuprofen tolerance and obtaining informed consent from the patients, we performed a sequential allergy workup including in vitro tests, skin tests, and finally DPT in two of the patients, confirming ibuprofen tolerance. In conclusion, although generally contraindicated, DPT may be considered for some useful drugs after careful evaluation of the risk–benefit balance, preceded by a sequential study including in vitro and skin tests.

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Early high-dose intravenous corticosteroids rapidly arrest Stevens Johnson syndrome and drug reaction with eosinophilia and systemic symptoms recurrence on drug re-exposure

Cited by 23 publications

References 8 publications

Updates and Insights in the Diagnosis and Management of DRESS Syndrome

Updates and Insights in the Diagnosis and Management of DRESS Syndrome

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

Drug reexposure in children with severe mucocutaneous reactions

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