Stevens-Johnson syndrome and toxic epidermal necrolysis

Parrillo, Steven J.

doi:10.1007/s11882-007-0036-9

Cited by 27 publications

(21 citation statements)

References 22 publications

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“…This is in keeping with literature where presentations of SJS typically occur within 3 weeks of drug exposure but can range from 4-28 days. 10 In addition, we show that the risk of recurrence is very low on challenge with EFV. One of 13 patients (8%) demonstrated occurrence of a new rash.…”

Section: Discussionmentioning

confidence: 65%

Efavirenz challenge in patients with nevirapine induced Stevens-Johnson Syndrome

Manzini

Gosnell

John

et al. 2015

Southern African Journal of Infectious Diseases

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Background: Non-nucleoside reverse transcriptase inhibitors (NNRTI) are recommended as part of first-line treatment by the World Health Organisation (WHO) for antiretroviral treatment (ART) naïve subjects. Due to reports of cross-toxicity between nevirapine (NVP) and efavirenz (EFV), there is reluctance to substitute EFV for NVP when serious toxicity occurs. In such cases lopinavir/ritonavir (LPV/r) remains the only alternative. We report on our experience of patients with Stevens-Johnson Syndrome (SJS) secondary to NVP who were challenged with EFV under careful supervision. Methods: A retrospective chart review of patients who presented with SJS presumed to be secondary to NVP who were challenged with EFV and were followed up for at least 2 months. Results: The study included 13 patients. All were female, median age 28 years and median weight 66.5 kg. The median CD4 cell count at ART initiation was 160 cells/μl. Twelve patients (92%) developed a rash within 4 weeks of NVP. The median alanine transaminase at SJS presentation was 30 U/l. The median time to EFV challenge was 30 days. The median hospital stay for SJS was 30 days and median follow up was 19 months. Eleven (85%) patients tolerated co-trimoxazole rechallenge, two had no prior exposure. Median hospital stay for EFV challenge was additional 10 days. Twelve patients (92%) tolerated the EFV challenge. One patient developed a pruritic maculo-papular eruption within 3 days of challenge which led to discontinuation of EFV. Conclusion: The risk of recurrence of SJS with EFV challenge in patients with NVP induced SJS is low. It is safe to challenge patients with EFV with careful observation.

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Section: Discussionmentioning

confidence: 65%

Efavirenz challenge in patients with nevirapine induced Stevens-Johnson Syndrome

Manzini

Gosnell

John

et al. 2015

Southern African Journal of Infectious Diseases

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Section: Scoring Your Patient's Prognosismentioning

confidence: 99%

“…1,3,6 Explain to your patient and his family that SJS is a slow-resolving syndrome and that the most important goals are comfort, pain control, adequate nutrition, and preventing complications. Score 1 point for each criterion your patient has: J age over 40 years J diagnosis of cancer J heart rate greater than 120 beats/minute J 10% skin detachment from bullae initially J blood urea nitrogen level greater than 10 mmol/L J serum glucose level greater than 14 mmol/L J bicarbonate level of less than 20 mmol/L.…”

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confidence: 99%

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Dodging the bullae

Holcomb¹

2007

Nursing

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Scoring your patient's prognosisTo assess a patient's risk of death from Stevens-Johnson syndrome (or from toxic epidermal necrolysis), calculate his SCORTEN score based on the factors below. Score 1 point for each criterion your patient has: J age over 40 years J diagnosis of cancer J heart rate greater than 120 beats/minute J 10% skin detachment from bullae initially J blood urea nitrogen level greater than 10 mmol/L J serum glucose level greater than 14 mmol/L J bicarbonate level of less than 20 mmol/L. The patient's risk of death, based on his score, is as follows: 0-1 = 3.2% or more, 2 = 12.1% or more, 3 = 35.3% or more, 4 = 58.3% or more, and more than 5 = 90% or more.www.nursing2007.com Nursing2007, April 64cc3 ness. Skeletal and muscle problems may include arthritis, arthralgia, and myalgia. 1,3,6 Explain to your patient and his family that SJS is a slow-resolving syndrome and that the most important goals are comfort, pain control, adequate nutrition, and preventing complications. Tell your patient to report any fever, tachypnea, or tachycardia, as these may indicate a secondary infection. Beating the oddsEarly diagnosis and removal of the offending trigger within 48 hours of onset can hasten recovery from SJS. Even dire cases can have good outcomes. One such case involved a 15-year-old girl diagnosed with SJS secondary to M. pneumoniae. She survived despite respiratory distress that required mechanical ventilation, acute renal failure that required hemodialysis, and numerous skin graft surgeries. Today, my former patient is a physician herself-and always alert when a patient presents with typical and atypical target skin lesions and mucosal lesions.‹›

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“…2 Approximately 50% of cases of SJS and 80-90% of cases of TEN are drug induced. 3 Common causative agents include sulfa drugs, antiepileptic drugs, antibiotics and NSAIDS. 4 Lamotrigine is an anti epileptic drug that is structurally unrelated to aromatic antiepileptics.…”

Section: Introductionmentioning

confidence: 99%

Lamotrigine Induced Toxic Epidermal Necrolysis in a Patient With Bipolar Disorder

Saldanha¹,

Torvi²,

Tophakhane³

2013

jemds

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Stevens-Johnsons syndrome and toxic epidermal necrolysis are the most severe cutaneous adverse reactions to medications. These are characterized by the detachment of dead epidermis and the erosion of mucus membrane. Lamotrigine is an antiepileptic drug used in the management of various forms of seizures. Lamotrigine is also useful in preventing the depressive phase of manic depressive disorder. We present a case of toxic epidermal necrolysis induced by Lamotrigine to increase the awareness to this life threatening adverse drug reaction to Lamotrigine, as Steven Johnson syndrome and Toxic epidermal necrolysis have a significant impact on public health in view of their high mortality and morbidity.

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Stevens-Johnson syndrome and toxic epidermal necrolysis

Cited by 27 publications

References 22 publications

Efavirenz challenge in patients with nevirapine induced Stevens-Johnson Syndrome

Efavirenz challenge in patients with nevirapine induced Stevens-Johnson Syndrome

Dodging the bullae

Lamotrigine Induced Toxic Epidermal Necrolysis in a Patient With Bipolar Disorder

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