Stevens-Johnson Syndrome Associated With Chlordiazepoxide

Abstract

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, acute, but serious cutaneous adverse reactions, associated with exposure to drugs and can result in significant morbidity and mortality. The incidence of SJS ranges from 1.2 to 6 per million per year, with fatality in up to 5% of cases, while TEN affects 0.4 to 1.2 per million per year with mortality in up to 30% of patients. 1-3 SJS and TEN are rare variants of severe, adverse cutaneous drug reactions characterized by extensive painful erythematous macules, eventually evolving to epidermal detachment and mucous membrane erosions resulting from massive apoptosis of epithelial cells. Distinguishing features of SJS and TEN from other morbilliform drug rashes is based on the manifestation of skin lesions and the extent of epidermal detachment. 4,5 SJS/ TEN are differentiated by the extent of epidermal detachment. SJS involves <10% body surface area detachment, while TEN is characterized by extensive involvement of >30% body surface area. 4,5 The exact pathophysiological mechanism has not been fully elucidated, but it is believed to be a delayed hypersensitivity reaction mediated by T1 helper cells. The reaction typically occurs 4 to 28 days after initiation of the offending drug, although the highest risk of developing SJS and TEN occurs in the first 2 months after exposure to the drug on a continuous basis. Both SJS and TEN may present with prodromal symptoms lasting up to 1 week, such as fever, sore throat, coughing, myalgia, and arthralgia. Following this period, cutaneous manifestations appear as discrete maculopapular rash, similar to a morbilliform rash. 4,5 Mucosal involvement is present in nearly all of the patients, whereas ocular and visceral involvement occurs less frequently. 4,5

Concomitance or consequence? Stevens‑Johnson syndrome in COVID‑19: A case report

“…Laboratory data. ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- This pathology represents a delayed reaction that usually occurs 4-28 days from the moment of exposure to a drug (29); thus, it is of utmost importance to conduct an in-depth anamnesis and a thorough retrospective pharmacological investigation for an extended period of time preceding the onset of skin manifestations.…”

“…This pathology represents a delayed reaction that usually occurs 4-28 days from the moment of exposure to a drug ( 29 ); thus, it is of utmost importance to conduct an in-depth anamnesis and a thorough retrospective pharmacological investigation for an extended period of time preceding the onset of skin manifestations.…”