Warfarin‐induced Stevens–Johnson syndrome with severe liver injury

Abstract

Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a life-threatening mucocutaneous disease that is predominantly drug-induced. Warfarin is the most commonly used drug for long-term anti-coagulant therapy; however, warfarin-induced SJS/TEN is seldom reported. In this study, we presented the case of a 61-year-old man who developed SJS after receiving multiple-drug therapy following aortic valve replacement surgery. The patient was diagnosed with drug-induced liver injury (DILI) based on significantly abnormal liver function test results. Warfarin was identified as the culprit drug using the algorithm of drug causality for epidermal necrolysis (ALDEN) score, enzyme-linked immunospot (ELISPOT) assay, and Roussel Uclaf Causality Assessment Method (RUCAM). After warfarin discontinuation and corticosteroid therapy, the lesions and liver function test findings improved. Human leukocyte antigen typing was conducted to detect the risk allele. To our knowledge, this is the first reported case of warfarin-induced SJS/TEN with DILI. This case suggests that commonly used and safe pharmaceutical agents such as warfarin can potentially cause serious adverse events, including SJS/TEN and DILI. The application of ALDEN, the ELISPOT assay, and RUCAM could be useful in identifying culprit drugs.

Unrecognized indication for aortic valve neocuspidization: Patient with warfarin‐induced Stevens–Johnson syndrome and toxic epidermal necrolysis

“…Sulfonamides, nonsteroidal anti‐inflammatory drugs, antiepileptics, and antibiotics are the drugs that most commonly cause SJS/TEN 4 . However, warfarin‐induced SJS/TEN is a very rare case 5,6 …”

“…4 However, warfarin-induced SJS/TEN is a very rare case. 5,6 Warfarin is the most commonly used drugs, especially after valve surgery. There are many conditions that were documented as a contraindication for Vitamin K antagonist (VKA's), however; with our case we also suggest that SJS/TEN may also be a contraindication for VKA.…”

Drug hypersensitivity, in vitro tools, biomarkers, and burden with COVID‐19 vaccines

“…Recently, two studies reported that patients with NIHSR to antibiotics were positive to the implicated drug on IFNy EliSpot testing, 26,27 improving diagnosis in severe phenotypes and helping on culprit antibiotics identification. Moreover, in another study, warfarin was confirmed as the culprit in SJS with severe liver injury using specific IFN‐γ‐releasing cells 28 . Likewise, the measurement of IFNγ‐releasing cells was key for identifying culprit drugs in a cohort of 27 patients with different clinical phenotypes of severe cutaneous adverse reactions SC 29 .…”

“…Moreover, in another study, warfarin was confirmed as the culprit in SJS with severe liver injury using specific IFN‐γ‐releasing cells. 28 Likewise, the measurement of IFNγ‐releasing cells was key for identifying culprit drugs in a cohort of 27 patients with different clinical phenotypes of severe cutaneous adverse reactions SC. 29 Finally, EliSpot assay using the combined detection of IFNγ‐, GrB‐, and IL‐5‐ releasing cells showed usefulness for diagnosing dapsone hypersensitivity syndrome.…”

“…4,[23][24][25] EliSpot assays can improve diagnosis in severe phenotypes and identification of culprit drugs. 5,[26][27][28][29] To improve the use of the EliSpot assays as diagnostic tool T-cell clones used as novel diagnostic tests to distinguish different disease. 30 To understand better the use of the T cells clones as diagnostic tests…”