Stevens-Johnson Syndrome associated with methotrexate treatment for acutelymphoblastic leukemia: a case report

Abstract

Toxic epidermal necrolysis and Stevens-Johnson syndrome are rare mucocutaneous diseases which are associated with a prolonged course and potentially lethal outcome. They are mostly drug induced and mortality rates are very high. Although mostly skin is involved, multiple organ systems such as cardiovascular, pulmonary, gastrointestinal, and urinary systems may be affected. Here, we report a case of Stevens- Johnson Syndrome associated with methotrexate treatment who developed acute cardiac failure and gastrointestinal hemorrhage beside skin findings. He had been treated with intravenous immunglobulin and methylprednisolone succesfully and continued chemotherapy with methotrexate treatment again.

<p>Severe Gastrointestinal Involvement in Pediatric Stevens-Johnson Syndrome: A Case Report and Review of the Literature</p>

“…Since its first description in 1949, 16 we have been able to identify only 14 pediatric cases of SJS/TEN with gastrointestinal involvement, five of which had isolated esophageal involvement (Table 1). [17][18][19][20][21][22][23][24][25][26][27] These five cases experienced the most common presentation of gastrointestinal tract involvement in children: progressive dysphagia weeks to years after the acute illness due to an esophageal stricture. [23][24][25][26][27] Watery diarrhea with blood and mucus is the second most common presentation, either at presentation or 2-3 weeks afterwards.…”

“…This immediate introduction of a short steroid course may have aided in the stabilization of his skin lesions and concomitant improvement of the gastrointestinal symptoms within 14 days. All but two previous pediatric cases report using steroids during the acute illness, 17,[20][21][22][23][24][25][26] and…”

“…Bechek five report using IVIG (Table 1). [20][21][22] One report had no information on acute management. 27 However, the usage of steroids, IVIG, or other immunosuppressive agents for the treatment of SJS/TEN remains highly controversial.…”

Dermatological toxicity of acute lymphoblastic leukemia treatment by protocol ALL IC-BFM 2002

“…Редко в подобных случаях развиваются печеночная, сердечно-сосудистая, дыхательная недостаточность, проявления кожной токсичности (синдром Стивенса-Джонсона и токсический эпидермальный некролиз). Лечебная тактика в подобных случаях включает проведение экстракорпоральных методов детоксикации, введение фолината кальция, иммуноглобулина и глюкокортикостероидов [7][8][9].…”