Use of Intravenous Immunoglobulin in Children With Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Seven Cases and Review of the Literature

Metry, Denise; Jung, Peter; Levy, Moise L.

doi:10.1542/peds.112.6.1430

Cited by 130 publications

(92 citation statements)

References 26 publications

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“…Furthermore, numerous other anti-inflammatory, immunosuppressive, and immunumodulatory agents (such as cyclosporine, cyclophosphamide and thalidomide) as well as intravenous immunoglobulin have been administered as possible means to arrest underlying immunological mechanisms promoting SJS [19]. However, the efficacy of these agents in the treatment of SJS has not been demonstrated in any controlled clinical trial.…”

Section: Discussionmentioning

confidence: 99%

Stevens-Johnson syndrome caused by combined use of lamotrigine and fluoxetine and review of the literature

et al. 2010

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AbstractStevens-Johnson syndrome (SJS) is a rare, life-threatening acute allergic drug reaction presenting with target lesions and blebs of epidermis. Although a variety of etiologies such as infections and underlying malignancies have been implicated as potential causes of SJS, drugs remain the predominant inciting agent. This report presents a SJS case due to combined use of lamotrigine and fluoxetine. A 41-year-old man was admitted to our clinic with fever, skin eruptions (especially on the face and trunk) and lesions around the mouth. The patient’s history revealed lamotrigine and fluoxetine use during the previous three weeks for major depression. Dermatological examination revealed a typical clinical picture of SJS; his psychotropic medications were all stopped. While topical and ocular prednisolone (1mg/kg/day) cares were initiated, steroid dosage was reduced within 15 days. The condition of patient rapidly improved through this treatment. Effective management of SJS begins with prompt recognition of the entity, combined with attention to each of the major organs that may be affected, potential comorbidities and withdrawal of all potentially causative drugs. Clinicians should bear in mind the possibility that drugs with potential risk in developing SJS must be used carefully.

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Section: Discussionmentioning

confidence: 99%

Stevens-Johnson syndrome caused by combined use of lamotrigine and fluoxetine and review of the literature

et al. 2010

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“…IVIG therapy has been shown to inhibit Fas-associated keratinocyte apoptosis. Metry et al [6] reported a response to IVIG therapy in one to seven days and a decrease in new vesicle formation in juvenile patients. A dose of 1-3 g/kg per day can be used for three to five days.…”

Section: Case Reportmentioning

confidence: 99%

Toxic Epidermal Necrolysis: A Case Report

Erdoğan¹

2016

J Clin Anal Med

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ÖzetSteven's Johnson Sendromu (SJS) ve toksik epidermal nekroliz (TEN), ciddi klinik tablolara ve mortaliteye sebep olabilen, deri ve mukozaların akut seyirli ve şiddetli reaksiyonlarıdır. Burada üst solunum yolu enfeksiyonu nedeniyle parasetamol, kodein fosfat ve klorfeniramin içeren tablet kullanımından sonra toksik epidermal nekroliz tablosu gelişen ve mortalite ile sonuçlanan olgu sunulmuştur. Çocuk hastalarda SJS ve TEN gibi ciddi klinik tablolara neden olabilecek durumlar göz önün-de bulundurulmalı, gereksiz ilaç kullanımından kaçınılmalıdır. Anahtar Kelimeler Steven-Johnson Sendromu; Toksik Epidermal Nekrolizis; İlaç Yan Etkileri AbstractStevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe, acute reactions of the skin and mucosa that can result in serious clinical outcomes and morbidity. We report a case of TEN resulting in mortality, following the use of tablets containing paracetamol, codeine phosphate, and chlorpheniramine for an upper respiratory tract infection. Conditions such as SJS and TEN that can lead to serious clinical outcomes should be considered in juvenile patients, and unnecessary drug use should be avoided.

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“…Although no large randomized controlled clinical trials for the use of IVIg have been conducted to date, case reports in children have shown marked improvement when IVIg is administered in patients with SJS and toxic epidermal necrolysis. 9 A recent Canadian review of SJS in children found that the use of IVIg and corticosteroids had similar outcomes in terms of infectious complications and length of stay, and that both of these treatments were better when compared with supportive therapy alone.…”

Section: Question: Is There a Role For Steroids Or Intravenous Immunomentioning

confidence: 99%

Stevens-Johnson Syndrome, Mucositis, or Something Else?

Milner

Mendez

2014

Hospital Pediatrics

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ILLUSTRATIVE CASE EIA is a recurring section of Hospital Pediatrics where expert pediatric hospitalists give their interpretation of the recent evidence in reference to common clinical questions encountered in their daily practice.Stevens-Johnson Syndrome, Mucositis, or Something Else?Stevens-Johnson syndrome (SJS) has been described in the literature as a combination of erythematous blistering skin lesions covering <10% of body surface area and ≥1 mucous membrane erosion.1 SJS is usually triggered by a medication or infection. Infectious causes are more common in children, most notably herpes simplex virus (HSV) and Mycoplasma pneumoniae. Mucous membrane erosions without signifi cant skin involvement have been classifi ed as "atypical SJS" and mucositis.2 Case: An 18-year-old high school senior presented to his physician with a 2-week history of sore throat and cough, 1-week history of fever, and 1-day history of swollen lips and mucosal ulcerations in his mouth accompanied by pain with swallowing. He was an otherwise healthy adolescent male, with the exception of a PICU admission for anaphylaxis without obvious trigger 8 years ago and attention-defi cit/hyperactivity disorder for which he is taking methylphenidate. The treating physician ordered a chest radiograph that demonstrated streaky infi ltrates in the right lower lobe and sent serology samples for Mycoplasma, immunoglobulin G (IgG) antibodies for HSV type 1 and 2, and HIV testing. The patient was started empirically on azithromycin and acyclovir, with lidocaine viscous for his mouth sores. The following day he developed conjunctival erythema, urethral ulceration, and continued to have poor oral intake; he was therefore admitted to the inpatient pediatric ward for intravenous hydration, pain control, and further observation. Question: Does this patient have SJS?Discussion: There is disagreement in the literature on the exact defi nition of SJS. As fi rst described by Stevens and Johnson in 1922, a patient must have a generalized skin eruption in conjunction with mucosal involvement to meet the defi nition.3 This patient never had a generalized skin eruption and therefore does not meet the classic criteria. He did, however, develop 1 targetoid lesion with a central blister on his glans penis, as well as meatal ulceration (Fig 1). In addition, the patient had bilateral nonexudative conjunctival erythema and oropharyngeal ulcerations seen externally on his lips (Fig 2).We characterized this illness as mucositis secondary to atypical pneumonia, not meeting the classic diagnosis of SJS due to lack of skin lesions. According to Schalock and Dinulos,4 patients with disease limited to the mucous membranes are not at risk for widespread skin involvement and often recover faster than children with skin involvement, making diagnosis important for prognosis. AUTHORS

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Use of Intravenous Immunoglobulin in Children With Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Seven Cases and Review of the Literature

Cited by 130 publications

References 26 publications

Stevens-Johnson syndrome caused by combined use of lamotrigine and fluoxetine and review of the literature

Stevens-Johnson syndrome caused by combined use of lamotrigine and fluoxetine and review of the literature

Toxic Epidermal Necrolysis: A Case Report

Stevens-Johnson Syndrome, Mucositis, or Something Else?

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