Etoricoxib-induced toxic epidermal necrolysis: A fatal case report

Abstract

Cyclooxygenase inhibitors were developed in the quest of enhanced analgesic efficacy devoid of gastric side effects. High usage of etoricoxib by prescription as well as self-administered routes has led to increasing reports of side effects and adverse reactions including dermatologic reactions in 0.1%–0.3% of cases. The present report enumerates a case of toxic epidermal necrolysis induced by etoricoxib.

Analgesia for Sheep in Commercial Production: Where to Next?

“…The importance of COX isoform selectivity relates to risk of adverse reactions, particularly associated with COX-1-mediated gastro-intestinal upsets, perforation and associated peritonitis, that have been reported in monogastrics [ 257 , 258 , 259 , 260 , 261 , 262 ] and it was assumed that a COX-2 selective agent would be free of such adverse effects. However, adverse cardiovascular, intestinal and other effects have been reported in humans or dogs associated with some COX-2 selective NSAIDs [ 259 , 262 , 263 , 264 , 265 , 266 , 267 , 268 , 269 , 270 , 271 , 272 , 273 , 274 , 275 , 276 , 277 , 278 , 279 , 280 , 281 , 282 , 283 , 284 , 285 , 286 ]. It is important to note here that COX-selectivity is a continuum, so an agent that is described as ‘COX-2 selective’ still has effects on COX-1, but the effects on COX-2 are evident at lower dose rates than the effects on COX-1 [ 275 , 276 ].…”

“…The coxibs are used widely in humans and dogs, with good effect [ 313 , 326 , 346 , 362 , 363 ]. They are markedly COX-1 sparing, but still are not exempt from severe adverse side-effects [ 262 , 284 ]. Oral cimicoxib has been evaluated in sheep, showing slow and very variable absorption rates, which may be associated with the relative insolubility of the agent [ 364 ].…”

Topical moxifloxacin-induced toxic epidermal necrolysis and Stevens-Johnson syndrome

“…Skin and mucous membrane are mainly involved, characterized by necrosis, detachment of epidermis, and exfoliation of the mucosa. [ 1 ] The involvement of mucus membrane is further complicated by sepsis, gastrointestinal bleeding, abnormalities of ocular and genitourinary systems, respiratory failure, and death. Skin detachment of body surface area is <10%, 10–30%, and >30% in SJS, SJS/TEN overlap, and TEN, respectively.…”

“…Drugs causing TEN/SJS are co-trimoxazole and other sulfonamides-such as sulfamethoxazole and sulfadiazine, anticonvulsants, cephalosporins, quinolones, and analgesics of the oxicam-type, antimetabolites, antiretroviral drugs, corticosteroids, and anxiolytics. [ 1 ]…”

“…The activation of interleukin-2 (IL-2) and TNF-α and recruitment of CD81 cells and CD41 T lymphocytes stimulate the chemotactic factors release, which leads to macrophage and natural killer cells recruitment into the epidermis, which in turn leads to massive destruction of epidermis. [ 1 ] Antigenic specificity has been attributed to moxifloxacin bicyclic ring structure at positions 7 and 8 on which the particular side chains are present and this may explain insufficiency of cross-reactivity with ciprofloxacin. Although moxifloxacin side chain specificity may be related to case report rates of allergic reactions attributed to it when compared to other fluoroquinolone drugs, there is a lack of definitive evidence for this.…”