Management of toxic epidermal necrolysis and related syndromes

Mukasa, Yosuke; Craven, N. M.

doi:10.1136/pgmj.2007.061465

Cited by 36 publications

(29 citation statements)

References 43 publications

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“…Due to the rarity of these disorders, there are no randomized controlled trials of pharmacological agents in the treatment for SJS and TEN. However, there are case reports of successful treatment using IVIG, systemic corticosteroids, plasmapheresis, cyclosporine, cyclophosphamide, antitumour necrosis factor-a (TNF-a) and haemodialysis (29).…”

Section: Discussionmentioning

confidence: 99%

Profile and Pattern of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in a General Hospital in Singapore: Treatment Outcomes

Tan

Tay²

2012

Acta Derm Venerol

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Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, but potentially life-threatening, reactions to medications. Both conditions have significant morbidity and mortality. The aim of this study was to document the epidemiological features, aetiologies, treatment and clinical outcomes of retrospectively reviewed data of all patients with SJS or TEN treated from January 2004 to November 2010 in a general hospital. There were 18 cases of SJS, seven cases of SJS/TEN overlap and three cases of TEN. Mean age was 50.6 years, with a range of 13-85 years. The male/female ratio was 1. Drugs accounted for 26 cases; one case was caused by Neisseria gonorrhoea infection. Anti-convulsants (35.7%) were the most common implicated drugs followed by antibiotics (28.5%), non-steroidal anti-inflammatory drugs (NSAIDS) (14.3%), allopurinol (7.1%) and traditional Chinese medication (7.1%). In seven cases, multiple drugs were implicated. Most SJS cases (88%) were treated with corticosteroids, of which 61% were given high-dose systemic corticosteroids. No infective complications were observed. Six out of the seven SJS/TEN overlap syndrome and all three TEN cases were given intravenous immunoglobulins. One patient with TEN died. In conclusion, anti-convulsants, especially carbamazepine, were the most frequently implicated drugs, followed by antibiotics and NSAIDS. High-dose corticosteroids were effective in SJS, whereas intra-venous immunoglobulin were useful in TEN and SJS/TEN overlap syndrome.

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Section: Discussionmentioning

confidence: 99%

Profile and Pattern of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in a General Hospital in Singapore: Treatment Outcomes

Tan

Tay²

2012

Acta Derm Venerol

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“…8 Other fatal complications include pulmonary embolism, adult respiratory distress syndrome, gastrointestinal hemorrhage, as well as cardiac and renal failure. 11 The SCORTEN developed by Bastuji-Garin et al 12 is a validated measure of disease severity, which may be used to estimate prognosis. It incorporates 7 clinical variables: age, malignancy, body surface area, heart rate, serum urea, bicarbonate, and glucose.…”

Section: Prognosismentioning

confidence: 99%

Toxic epidermal necrolysis: Review of pathogenesis and management

Downey

Jackson²,

Harun

et al. 2012

Journal of the American Academy of Dermatology

138

167

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“…The most common cause of death is sepsis induced by skin infections, particularly involving Staphylococcus aureus and/or Pseudomonas aeruginosa (24). More extensive epidermal detachment, increased age, increased blood urea nitrogen concentration, and visceral involvement indicate a poorer prognosis.…”

Section: Discussionmentioning

confidence: 99%

Severe Pneumonia Caused by Combined Infection with Pneumocystis jiroveci, Parainfluenza Virus Type 3, Cytomegalovirus, and Aspergillus fumigatus in a Patient with Stevens-Johnson Syndrome/toxic Epidermal Necrolysis

Lee¹,

Bae²,

Park³

et al. 2010

Acta Derm Venerol

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Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe adverse cutaneous reactions to drugs. We report here the first case of severe pneumonia caused by an unusual combined infection with Pneumocystis carinii (jiroveci), parainfluenza virus type 3, cytomegalovirus and Aspergillus fumigatus in a 63-year-old female patient with allopurinol-induced SJS/TEN overlap syndrome. Following treatment with high-dose systemic corticosteroids and intravenous immunoglobulin for SJS/TEN, her mucocutaneous lesions improved and she was due to be discharged. However, 15 days after cessation of corticosteroids, she developed pneumonia. Broncho-alveolar lavage revealed that the cause of infection was Pneumocystis carinii (jiroveci), parainfluenza virus type 3, cytomegalovirus and Aspergillus. These findings indicate that patients with SJS/TEN, particularly those treated with systemic corticosteroids, may be susceptible to infection with combinations of pathological agents resulting from damage to the bronchial epithelia.

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Management of toxic epidermal necrolysis and related syndromes

Cited by 36 publications

References 43 publications

Profile and Pattern of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in a General Hospital in Singapore: Treatment Outcomes

Profile and Pattern of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in a General Hospital in Singapore: Treatment Outcomes

Toxic epidermal necrolysis: Review of pathogenesis and management

Severe Pneumonia Caused by Combined Infection with Pneumocystis jiroveci, Parainfluenza Virus Type 3, Cytomegalovirus, and Aspergillus fumigatus in a Patient with Stevens-Johnson Syndrome/toxic Epidermal Necrolysis

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