Study on 98 patients with SJS and Lyell were treated at the Department of Allergology and Clinical immunology in Bach Mai Hospital (1997-2002). SJS & TEN always occurred when patients used the ampicillin and antibiotics of beta-lactam family, carbamazepine and anti-convulsion drugs properly or not. The symptoms of SJS & TEN appeared late (1-7 days) with 9 common clinical symptoms such as mucous membrane ulcerations, erythema, bullas and fever, etc. SR, uremia, enzymes of liver cells and proteinuria went up, that were main changes in blood test and urine test of SJS & TEN patients. Treating time was long-lasting, for SJS was 14.298.83 days, for Lyell syndrome is 19.716.6 days, with 4 main drugs: methyl-prednisolon, dimedrol, glycerin borate, and 5% glucose solution. There was no dead at that time.
Stevens-Johnson Syndrome ; Epidermal Necrolysis, Toxic ; Hypersensitivity ; Pharmaceutical Preparations

Objective: To recognize the common ocular signs and symptoms of toxic epidermal necrolysis (TEN), differentiate it from similar diseases, give the appropriate management, and provide continuity of care. Methods: This is a case report of a 21-year-old female patient admitted for ocular involvement of TEN secondary to an acute food reaction and an adverse drug reaction to intravenous cloxacillin. Results: The patient had hyperemic conjunctivae with infiltration, mucopurulent discharge, and pseudomembrane formation with a corneal epithelial defect. The ocular symptoms were treated with copious irrigation of the conjunctival sac, daily membrane peeling, topical antibiotics, and topical steroids. The patient was advised regular follow-up to prevent symblepharon formation. Conclusion With the appropriate diagnosis and management of TEN, ocular symptoms may be relieved and complications prevented.
Epidermal Necrolysis ; Toxic Drug Toxicity Scalded-Skin Syndrome

This is the first case report to describe a 44-year-old woman with a history of advanced hepatocellular carcinoma who developed toxic epidermal necrolysis (TEN) clinically after taking 400 mg sorafenib (Nexavar(R), BAY 43-9006) and tosufloxacin orally once per day. Both sorafenib and tosufloxacin were eventually discontinued, and the TEN resolved with corticosteroids and supportive treatment. Clinical physicians should be aware of this possible complication so that early interventions can be made.
Adrenal Cortex Hormones ; Adult ; Bays ; Carcinoma, Hepatocellular ; Early Intervention (Education) ; Epidermal Necrolysis, Toxic ; Female ; Fluoroquinolones ; Humans ; Naphthyridines ; Niacinamide ; Phenylurea Compounds

Toxic epidermal necrolysis (TEN) is an unpredictable, acute inflammatory systemic condition that involves injury to the skin, mucous membranes, and bowel and respiratory epithelium. Pulmonary complications are often observed and usually show an acute form. However, chronic pulmonary complications are rare and little is known about the clinical manifestations. We herein report a 51-year-old woman who presented with chronic pulmonary complications after recovery from TEN. A diagnosis of chronic bronchiolitis obliterans was made with upper respiratory tract obstruction and bronchiectasis.
Bronchiectasis ; Bronchiolitis Obliterans ; Epidermal Necrolysis, Toxic ; Female ; Humans ; Middle Aged ; Mucous Membrane ; Respiratory Mucosa ; Respiratory System ; Skin

Toxic epidermal necrolysis (TEN) is the most severe form of skin reactions caused by drugs or infection. Acute pulmonary complications in TEN are often observed. The mortality is especially high in those who suffer chronic pulmonary complications of TEN such as bronchiolitis obliterance, which occur as a consequence of bronchial epithelial injury. We report a case of a 16-year-old male who had required mechanical ventilation due to acute respiratory distress syndrome caused by TEN at 8 years of age. Although the patient initially recovered from acute respiratory distress syndrome, he required mechanical ventilation again due to severe chronic pulmonary complications of bronchiolitis obliterance and bronchiectasis caused by respiratory epithelial detachment. Thereafter, chronic bronchitis and chronic sinusitis has persisted due to mucosal ciliary dysfunction and several episodes of spontaneous pneumothorax has occurred. However, despite these persisting and serious sequelae of TEN, the patient has survived for 8 years. We report a rare case of a patient with long-term chronic pulmonary complications who had previously suffered TEN 8 years ago.
Adolescent ; Bronchiectasis ; Bronchiolitis ; Bronchitis, Chronic ; Epidermal Necrolysis, Toxic* ; Humans ; Male ; Mortality ; Pneumothorax ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; Sinusitis ; Skin

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the potentially life-threatening, acute hypersensitivity reaction to inciting drugs. These diseases have been often associated with systemic carbonic anhydrase inhibitor such as acetazolamide or methazolamide in Korean and Japanese patients. Dorzolamide is a recently developed topical carbonic anhydrase inhibitor with few significant systemic adverse effects. To the best of our knowledge, there have been only a few reports of SJS or TEN caused by topical dorzolamide in the literature. We herein present two cases of TEN and one case of SJS related with topical use of dorzolamide. It should be emphasized that although rarely, topical dorzolamide may cause serious sulfonamide hypersensitivity such as SJS or TEN in the susceptible patient through the systemic absorption.
Absorption ; Acetazolamide ; Asian Continental Ancestry Group ; Carbonic Anhydrases ; Epidermal Necrolysis, Toxic ; Humans ; Hypersensitivity ; Methazolamide ; Stevens-Johnson Syndrome ; Sulfonamides ; Thiophenes

Toxic epidermal necrolysis (TEN) is a rare disease in absolute numbers with an incidence of 2 cases per million people per year. Most cases of TEN are caused by drugs, but certain infectious diseases may have an impact on the risk. There are rare reports of TEN occurring without history of drug ingestion in systemic lupus erythematosus (SLE), appearing similar to cutaneous lupus and early TEN manifestations, such as erythema multiforme. This report describes a patient with SLE who presented with manifestations of TEN after ceftriaxone treatment. The patient was newly diagnosed with SLE and TEN occurring eight days after cessation of ceftriaxone. Considering possible etiologies, we could not exclude ceftriaxone as the cause of TEN. After intravenous immunoglobulin with glucocorticoid, clinical symptoms improved.
Ceftriaxone* ; Communicable Diseases ; Eating ; Epidermal Necrolysis, Toxic* ; Erythema Multiforme ; Humans ; Hydroxychloroquine ; Immunoglobulins ; Incidence ; Lupus Erythematosus, Systemic* ; Rare Diseases

Brinzolamide and dorzolamide are highly specific topical carbonic anhydrase inhibitors (CAIs). They lower intraocular pressure (IOP) by reducing the rate of aqueous humour formation without serious side effects. Although systemic CAIs are the most potent medications for lowering intraocular pressure for conditions with ocular hypertension, many cases with adverse systemic reactions have been reported, including Stevens-Johnson syndrome (SJS) and Toxic epidermal necrolysis (TEN). Here, we report 2 cases of TEN that were associated with topical CAIs rather than systemic CAIs.
Carbon ; Carbonic Anhydrase Inhibitors ; Carbonic Anhydrases ; Epidermal Necrolysis, Toxic ; Intraocular Pressure ; Ocular Hypertension ; Stevens-Johnson Syndrome ; Sulfonamides ; Thiazines ; Thiophenes

Toxic epidermal necrolysis (TEN) is an exfoliative disease of skin and characterized by flaccid bullae and spreading erythema so that the skin has the appearance of being scalded. It results primarily from a toxic reaction to various drugs, but occasionally occurs as a result of infection, neoplastic conditions, or other exposure. Enterovirus 71 (EV 71), the most recently described serotype of the genus Enterovirus (family Picornaviridae), causes a variety of diseases, including aseptic meningitis, encephalitis, poliomyelitis-like paralysis, hand-foot-mouth disease, gastroenteritis, fever and rash. A 3-year-old boy presented at the Department of Pediatrics, Soonchunhyang University Cheonan Hospital due to TEN. There were no definite causes such as drug toxicity, Graft-Versus-Host disease (GVHD) and infection. However, we could have isolated EV 71 from the patient's stool. Until now, there have been no reports showing the relationship between EV 71 and TEN, we report here in a case of TEN-associated with EV 71. Further evaluation is needed to study the relationship of TEN with EV 71.
Blister ; Child ; Drug Toxicity ; Encephalitis ; Enterovirus ; Epidermal Necrolysis, Toxic ; Erythema ; Exanthema ; Fever ; Gastroenteritis ; Graft vs Host Disease ; Humans ; Meningitis, Aseptic ; Paralysis ; Pediatrics ; Preschool Child ; Skin ; Stress, Psychological

A patient who was transferred to our Emergency Medical Center from a local clinic with a dermatologic disorder of unknown origin presented to us with TEN with a 40% skin slough. The patient was a 53-year-old women with complaints of erythematous rash and blisters on her trunk and both proximal extremities. She had taken NSAIDS, 1300 mg per oral, every 8 h for 5 days. Five days after administration of NSAIDS began, the doctors at the local clinic noted that a rash with blisters had begun on her back and progressed to her extremities. After 4 days of that progression she came to us. On physical examination, she had asymptomatic multiple clear filled bullae and erosion with brown- to black-colored hyperpigmentation on her trunk and proximal extremities involving 40% of the body surface. She was admitted to a private room to prevent secondary infections, and her management included fluid replacement, third-generation cephalosporin and corticosteroid administration, and intensive wound care. Fifteen days after admission, no further treatment was required, and only a small scar and a mild dispigmentation lesion could be seen. Emergency department physicians should think about TEN if the patient has extensive exfolating skin lesions. Treatment of patients with suspected TEN must be directed at minimizing fluid and electrolyte loss and preventing secondary infection, and an effort should be made to identify the suspicious drug and to educate patient to avoid the drug.
Anti-Inflammatory Agents, Non-Steroidal ; Blister ; Cicatrix ; Coinfection ; Emergencies ; Epidermal Necrolysis, Toxic ; Exanthema ; Extremities ; Female ; Humans ; Hyperpigmentation ; Middle Aged ; Patients' Rooms ; Physical Examination ; Porphyrins ; Skin