Lupus Erythematosus and Stevens-Johnson Syndrome

Abstract

Erythema multiforme exudativum Stevens-Johnson syndrome) has been described in association with the administration of numerous medications, including sulfonamides,1-6 penicillin,7 thiouracil,5 phenylbutazone,8 salicylates, codeine,9 Fowler's solution,10 phenolphthalein,7 barbiturates,11,12 trimethadione,13 and diphenylhydantoin.14-16 A reversible, lupus-like disease, characterized by the L.E. cell phenomenon, with or without renal and systemic involvement, has also been attributed to medications such as hydralazine,17-22 penicillin,23,24 phenylbutazone,17 sulfadiazine,25,26 and methylphenylethylhydantoin (Mesantoin) .27It is the purpose of this paper to report the simultaneous occurrence of erythema multiforme exudativum and a reversible, lupus-erythematosus-like disease in 2 adoles-cent girls, as well as acute lupus erythematosus alone in a 4-year-old boy, following medication with anticonvulsant drugs. Report of CasesCase 1.\p=m-\Atthe age of 7\ m=1/ 2\years, this girl began experiencing petit mal seizures characterized by momentary lapses of consciousness, substantiated by typical 3-per-second spike and wave dis¬ charges on the electroencephalogram. She was given trimethadione (Tridione), 900 mg. daily, and phénobarbital, 45 mg. daily. Over the next 3Vi years, the seizures were controlled by variable amounts of these 2 medications.In 1954, at the age of 11 years, the patient de¬ veloped erythema multiforme exudativum (Stevens-Johnson syndrome), with scattered bullous skin lesions, mucous membrane vesiculation and ero¬ sion, conjunctivitis, fever, and malaise. Laboratory studies included a hemoglobin of 14 gm. '% ; a white blood count of 5,100, with 38% neutrophils, 53% lymphocytes, and 9% eosinophils; and an erythrocyte sedimentation rate of 10 mm/hour. Urinalysis was normal. Two L.E. clot tests were negative. The patient was treated with hydrogen peroxide soaks and 1% neomycin ointment applied to the more severe local lesions. Trimethadione and phénobarbital were discontinued, and the anti¬ convulsant medication changed to Mebroin (a synergistic combination of mephobarbital and diphenylhydantoin) 3 tablets daily, and paramethadione (Paradione), 300 mg. a day.Mild skin lesions recurred intermittently during the next 3 years. Then, in 1957, at age 14, the patient developed fever, cough, more extensive oral and genital lesions, and paronychia (Fig. 1).The lesions were identified as a recrudescence

The Risk-Benefit Ratio of Anticonvulsant Drugs

“…Phenytoin and ethosuximide intake have both been associated with the presence of circulating antinuclear 328 antibodies in occasional patients (Beernink & Miller 1973). Reversible instances of systemic lupus erythematosus have been reported in patients taking phenytoin, primidone, carbamazepine and ethosuximide (Rallison et al 1961;Simpson 1966;Singsen et al 1976). Rarely, phenytoin intake has been associated with the development of a pseudolymphoma syndrome with Hodgkin-like histological features, which resolves on cessation of the drug (Saltzstein & Ackerman 1959).…”

Lupus eritematoso diseminado (L. E. D.)

“…y analizan otros descritos en la literatura, atribuyéndolos al P AS más que a la isoniazida. Tales casos, como los relacionados con otras drogas (Tetraciclina, Penicilina) 1 º Apresolina 11 , drogas anticonvulsivantes (concretamente la Trimetidiona) 12 Mesantoi- 13 , tienen de común el presentarse en relación con la medicación y desaparecer con la supresión de la misma.…”

Immunity and Systemic Lupus Erythematosus

“…20 Although hydralazine is the cla~sic drug associated with the production of the LE syndrome, methylphenylethyl hydantoin (MESANTOIN®), diphenylhydantoin (DILAN-TIN®), penicillin, sulfonamides, phenylbutazone and oxytetracycline have all been incriminated. 21 Since it has been shown that harmful complexes are generally formed only when there is a slight to moderate excess of antigen, remission of this drug-induced syndrome should rather rapidly follow withdrawal of the offending agent. This is indeed the case, and within rather short order the fever, positive LE preparations, joint and 624 other manifestations usually revert to normal.…”