Erythematous and bullous rash strongly indicating toxic epidermal necrolysis associated with the use of intravenous ritodrine hydrochloride

Shiba, Masahiro; Kido, Koji; Umezawa, Kazuo; Higaki, Hiroshi; Matsumoto, Soiti; Taguchi, Akinori; Hayashi, Takashi; Higaki, Yuko; Sasamori, Yukifumi; Shinozuka, Noriko; Fuse, Y; Kikuchi, Akihiko; Ayabe, Takuya

doi:10.1111/j.1447-0756.2010.01173.x

Cited by 5 publications

(2 citation statements)

References 12 publications

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“…We speculate that the rash was nearly impossible to be caused by indomethacin but the reasons were not sufficient. One case of TEN was found in English literature, which indicated that it may be caused by ritodrine hydrochloride[ 12 ]. In our case, ritodrine hydrochloride had been used until the day of surgery as she had experienced frequent contractions while her condition worsened with time.…”

Section: Discussionmentioning

confidence: 99%

Toxic epidermal necrolysis induced by ritodrine in pregnancy: A case report

Yu¹,

Zhang²,

Xu³

et al. 2022

WJCC

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BACKGROUND Preterm birth accounts for about 12% of all pregnancies worldwide and is the leading cause of neonatal morbidity and mortality. In order to avoid premature birth and prolong gestational age, tocolytics are the first and the best choice. Ritodrine is the most commonly used tocolytic medication. However, side effects such as pulmonary edema, hypokalemia, and hyperglycemia are known. Here we report a rare but serious side effect–toxic epidermal necrolysis (TEN)–caused by ritodrine. CASE SUMMARY A woman (31 years, gravida 4, para 2) was hospitalized because of premature contractions at 27 + 6 wk of gestation. A skin rash with pruritus appeared at 32 + 3 wk of gestation after administration of ritodrine, indomethacin, and dexamethasone, and it spread throughout the whole body in 3 d, particularly the four limbs. After 11 d’ treatment, she was diagnosed with TEN. An emergency cesarean section was performed immediately to deliver the baby and intensive symptomatic treatment was promptly commenced after delivery. She recovered from the severe condition without any sequelae except for slight pigmentation after symptomatic treatment. CONCLUSION When a skin rash appears during the administration of ritodrine, we are supposed to consider the risk of TEN.

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Section: Discussionmentioning

confidence: 99%

Toxic epidermal necrolysis induced by ritodrine in pregnancy: A case report

Yu¹,

Zhang²,

Xu³

et al. 2022

WJCC

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“… BSA, body surface area; CS, cesarean section; GA, gestational age; ICU, intensive care unit; IVIG, intravenous immunoglobulin; LOE, level of evidence; Rx, prescription; SJS, Stevens-Johnson syndrome; TEN, toxic epidermal necrolysis; Tx; treatment. References: Agboghoroma et al, 2010 , Ahiskalioglu et al, 2017 , Claessens et al, 1998 , de Haan et al, 2018 , Dube et al, 2013 , Graham-Brown et al, 1981 , Hitti et al, 2004 , Joao et al, 2006 , Knight et al, 2015 , Lee et al, 2010 , Leung, 1985 , Marazzi et al, 2006 , Niemeijer et al, 2009 , Pacheco et al, 2002 , Rodriguez et al, 2006 , Shiba et al, 2010 , Shilad et al, 2005 , Stewart et al, 2016 , Struck et al, 2010 , Sweetnam et al, 1964 , Treichler and Horvath, 1964 , Ugburo et al, 2009 , Vasicka et al, 1958 , Velter et al, 2018 , Winston and Mastroianni, 1954 , Yanagida, 2002 . …”

Section: Methodsmentioning

confidence: 99%

Stevens-Johnson syndrome and toxic epidermal necrolysis in pregnant patients: A systematic review

Sharma

Hedayati

Mesinkovska

et al. 2020

International Journal of Women's Dermatology

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Background Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are two of the most severe dermatologic emergencies. Although pregnant women comprise a subset of individuals at risk for SJS and TEN development, little is known with regard to outcomes and treatment. Objective This study aimed to conduct a systematic review to characterize the risk factors, outcomes, and treatment of SJS and TEN in pregnant patients and newborns. Methods A primary literature search was conducted using PubMed in September 2019, using the following search terms entered in separate pairs: pregnant or pregnancy and stevens-johnson or SJS or toxic epidermal necrolysis. Reviews, studies in a language other than English, and articles not including pregnant patients were excluded. Results Twenty-six articles were included for review, including a total of 177 patients. The average maternal age for a reaction was 29.9 years, gestational age was 24.9 weeks, and time to reaction after drug initiation was 27.5 days. Approximately 85% of pregnant women in this review were infected with HIV. The most common causative medications were antiretroviral therapy (90% of all cases), antibiotics (3%), and gestational drugs (2%). Of the 94 cases in which outcome data were available, the survival rates of pregnant women and newborns after delivery were 98% and 96%, respectively. Withdrawal of the offending agent and supportive care was often sufficient for treatment, but antibiotics, steroids, and intravenous immunoglobulin were implemented in some cases. Complications included preterm labor, vaginal stenosis, and vaginal adhesions. Conclusion Given the predominance of studies focusing on the subset of pregnant patients who are infected with HIV, SJS and TEN is most commonly reported in young patients after antiretroviral therapy, primarily nevirapine. Overall mortality is lower than that of the general population, but similar to the expected mortality rates of younger adults. Early recognition and withdrawal of the offending agent is essential to mitigate the distinct consequences of these conditions in the pregnant population.

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Drugs that affect autonomic functions or the extrapyramidal system

Aronson¹

2012

A Worldwide Yearly Survey of New Data in Adverse Drug Reactions and Interactions

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Erythematous and bullous rash strongly indicating toxic epidermal necrolysis associated with the use of intravenous ritodrine hydrochloride

Cited by 5 publications

References 12 publications

Toxic epidermal necrolysis induced by ritodrine in pregnancy: A case report

Toxic epidermal necrolysis induced by ritodrine in pregnancy: A case report

Stevens-Johnson syndrome and toxic epidermal necrolysis in pregnant patients: A systematic review

Drugs that affect autonomic functions or the extrapyramidal system

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