Toxic epidermal necrolysis-like acute cutaneous lupus erythematosus in a patient with progressive systemic sclerosis

Aiempanakit, Kumpol; Chiratikarnwong, Kanokphorn; Juthong, Siriporn; Auepemkiate, Sauvarat

doi:10.1177/0961203318789766

Cited by 1 publication

(1 citation statement)

References 12 publications

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“…The strongest of HLA associations are HLA-B∗58:01 with allopurinol-induced hypersensitivity syndrome and SJS/TEN in Asian populations. [17] HLA-B∗58:01 in patients of all ethnicities administered with allopurinol are at high risk for SJS/TEN. Allopurinol, a xanthine oxidase inhibitor that blocks uric acid production, is used for the treatment of chronic gout, uric acid nephrolithiasis, and hyperuricemia secondary to tumor lysis syndrome.…”

Section: Discussionmentioning

confidence: 99%

Allopurinol-induced toxic epidermal necrolysis featuring almost 60% skin detachment

Wang

2019

Medicine

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Rationale: Toxic epidermal necrolysis (TEN) is a life-threatening, immunologically mediated, and usually drug-induced disease. Rarely, clinical pharmacists participating in finding the etiology have been reported. Patients concerns: A 33-year-old male presented to the emergency department with a 1-day history of fever and rash. The patient, being newly diagnosed with gout 10 days ago, received allopurinol at a dose of 250 mg by mouth daily. After 10 days’ exposure to allopurinol, the patient manifested with an “influenza-like” prodromal phase (fever of 38°C, throat pains), which was treated with amoxicillin and nonsteroidal anti-inflammatory drugs of the oxicam type. The next day, he developed a worsening fever of 39.5°C, accompanied by a pruriginous rash all over his body. Diagnosis: On physical examination, we observed coalescing dusky red macules over >60% of his body surface area, with blisters and detachment of large sheets of necrolytic epidermis all over his chest and face. The diagnosis of TEN was confirmed. Interventions: The patient recovered following treatment with short-term high-dose methylprednisolone sodium succinate, immunoglobulin therapy, topical medication, and supportive therapy. Outcomes: He showed a slow but progressive improvement both in symptoms and cutaneous manifestations. Reepithelization of the skin was achieved after 3 weeks. Lessons: Drug-induced-TEN is potentially fatal. This case underlines the necessity of asking medication history in detail and detecting related drug gene to correctly identify the cause of TEN.

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Section: Discussionmentioning

confidence: 99%

Allopurinol-induced toxic epidermal necrolysis featuring almost 60% skin detachment

Wang

2019

Medicine

View full text Add to dashboard Cite

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Toxic epidermal necrolysis-like acute cutaneous lupus erythematosus in a patient with progressive systemic sclerosis

Cited by 1 publication

References 12 publications

Allopurinol-induced toxic epidermal necrolysis featuring almost 60% skin detachment

Allopurinol-induced toxic epidermal necrolysis featuring almost 60% skin detachment

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