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

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

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) and Stevens-Johnson syndrome (SJS) are rare, life-threatening mucocutaneous diseases, usually attributable to drugs and infections. Corticosteroids have been used in the management of TEN for the last 30 years. This remains controversial and is still much debated. TEN can occur despite administration of high doses of systemic corticosteroids. The psychiatric side effects of corticosteroids can include headache, insomnia, depression, and mood disorders with or without psychotic episodes. Steroid-induced psychosis is dealt with by tapering or discontinuing the steroid; antipsychotics are also sometimes used. We report a case of an 11-year-old boy who was admitted with TEN. He had also been diagnosed as having nephrotic syndrome in the past. Remission was achieved through induction therapy and by maintaining the use of steroids. After a full-dose intravenous dexamethasone for TEN, he showed psychotic symptoms. We diagnosed him as having steroid-induced psychosis. We tapered the steroid use and initiated an atypical antipsychotic medication, olazapine and intravenous immunoglobulin (IV-IG). His symptoms dramatically improved and he was discharged.
Adrenal Cortex Hormones ; Antipsychotic Agents ; Child ; Depression ; Dexamethasone ; Epidermal Necrolysis, Toxic ; Headache ; Humans ; Immunoglobulins ; Mood Disorders ; Nephrotic Syndrome ; Psychotic Disorders ; Sleep Initiation and Maintenance Disorders ; Steroids ; Stevens-Johnson Syndrome

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe, diffuse mucocutaneous reactions that can be elicited by drugs, infection, malignancy, and herbal supplements. A wide variety of mucocutaneous events, such as systemic contact dermatitis, have been reported to be elicited by Rhus chicken, although cases of SJS and TEN are rare. Here, we present a case of SJS caused by Rhus-chicken ingestion. A 48-year-old man who wanted to improve his health and treat a gastrointestinal problem ingested Rhus chicken in the traditional manner. Twenty-four hours later, he developed a multiple erythematous maculopapular skin rash with vesicles and bullaes on 30% of the body surface and multiple erosions on the lips. He was diagnosed with SJS/TEN and showed characteristic clinical findings induced by Rhus chicken. After the patient stopped Rhus-chicken ingestion and received methylprednisolone and antibiotics, his symptoms, signs, and laboratory findings improved. With this case, we emphasize that SJS and TEN can occur after ingesting Rhus chicken, although the incidence is very low.
Acute Kidney Injury ; Anti-Bacterial Agents ; Blister ; Chickens ; Dermatitis, Contact ; Eating ; Epidermal Necrolysis, Toxic ; Exanthema ; Humans ; Incidence ; Lip ; Methylprednisolone ; Middle Aged ; Rhus ; Stevens-Johnson Syndrome

PURPOSE: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), potentially life-threatening skin diseases with organ failures caused by drugs, require specialized intensive care. However, SJS and TEN have usually been managed in general wards and intensive care units by most doctors. This study describes the efficacy of treatment in the burn intensive care unit (BICU) compared to previous general treatments. METHODS: To investigate the clinical features, outcomes and benefits of 11 patients with SJS and TEN treated in our burn intensive care unit. Data on 11 patients who were treated between January 2004 and December 2008 were collected via a retrospective chart review. Also, the data were reviewed with previous literatures on SJS and TEN treatments. RESULTS: Patients were classified with overlap SJS/TEN (n=4, 36.36%) or TEN (n=7, 63.64%). Nonsteroidal anti-inflammatory drugs (NSAIDs) were the most common causative agents. Hepatitis was the most common organ involvement in both overlap SJS/TEN (n=1, 9.1%) and TEN (n=4, 36.36%). Renal dysfunction (n=4, 36.36%) and respiratory disorders (n=3, 27.27%) were seen in some cases. Mean time of total reepithelization was 9 days and mean hospital day was 14.66 days. Two patients with TEN died from sepsis with multi-organ failure, and the mortality rate was 18.18%. CONCLUSION: Adequate treatment of SJS and TEN in the BICU supports efficacy with a low mortality rate, short healing time, short hospitalization and fewer complications.
Burns ; Critical Care ; Epidermal Necrolysis, Toxic ; Hepatitis ; Hospitalization ; Humans ; Intensive Care Units ; Patients' Rooms ; Retrospective Studies ; Sepsis ; Skin Diseases ; Stevens-Johnson Syndrome

Drug allergy to antibiotics may occur in the form of immediate or non-immediate (delayed) hypersensitivity reactions. Immediate reactions are usually IgE-mediated whereas non-immediate hypersensitivity reactions are usually non-IgE or T-cell mediated. The clinical manifestations of antibiotic allergy may be cutaneous, organ-specific (e.g., blood dyscracias, hepatitis, interstitial nephritis), systemic (e.g., anaphylaxis, drug induced hypersensitivity syndrome) or various combinations of these. Severe cutaneous adverse reactions manifesting as Stevens Johnson syndrome or toxic epidermal necrolysis (TEN) may be potentially life-threatening. The management of antibiotic allergy begins with the identification of the putative antibiotic from a detailed and accurate drug history, complemented by validated in-vivo and in-vitro allergological tests. This will facilitate avoidance of the putative antibiotic through patient education, use of drug alert cards, and electronic medical records with in-built drug allergy/adverse drug reaction prescription and dispensing checks. Knowledge of the evidence for specific antibiotic cross-reactivities is also important in patient education. Apart from withdrawal of the putative antibiotic, immunomodulatory agents like high-dose intravenous immunoglobulins may have a role in TEN. Drug desensitization where the benefits outweigh the risks, and where no alternative antibiotics can be used for various reasons, may be considered in certain situations. Allergological issues pertaining to electronic drug allergy alerts, computerized physician prescriptions and decision support systems, and antibiotic de-escalation in antimicrobial stewardship programmes are also discussed.
Anaphylaxis ; Anti-Bacterial Agents ; Complement System Proteins ; Drug Hypersensitivity ; Electronic Health Records ; Electronics ; Electrons ; Epidermal Necrolysis, Toxic ; Hepatitis ; Hypersensitivity ; Immunoglobulins, Intravenous ; Patient Education as Topic ; Prescriptions ; Stevens-Johnson Syndrome ; T-Lymphocytes

Drug allergy to antibiotics may occur in the form of immediate or non-immediate (delayed) hypersensitivity reactions. Immediate reactions are usually IgE-mediated whereas non-immediate hypersensitivity reactions are usually non-IgE or T-cell mediated. The clinical manifestations of antibiotic allergy may be cutaneous, organ-specific (e.g., blood dyscracias, hepatitis, interstitial nephritis), systemic (e.g., anaphylaxis, drug induced hypersensitivity syndrome) or various combinations of these. Severe cutaneous adverse reactions manifesting as Stevens Johnson syndrome or toxic epidermal necrolysis (TEN) may be potentially life-threatening. The management of antibiotic allergy begins with the identification of the putative antibiotic from a detailed and accurate drug history, complemented by validated in-vivo and in-vitro allergological tests. This will facilitate avoidance of the putative antibiotic through patient education, use of drug alert cards, and electronic medical records with in-built drug allergy/adverse drug reaction prescription and dispensing checks. Knowledge of the evidence for specific antibiotic cross-reactivities is also important in patient education. Apart from withdrawal of the putative antibiotic, immunomodulatory agents like high-dose intravenous immunoglobulins may have a role in TEN. Drug desensitization where the benefits outweigh the risks, and where no alternative antibiotics can be used for various reasons, may be considered in certain situations. Allergological issues pertaining to electronic drug allergy alerts, computerized physician prescriptions and decision support systems, and antibiotic de-escalation in antimicrobial stewardship programmes are also discussed.
Anaphylaxis ; Anti-Bacterial Agents ; Complement System Proteins ; Drug Hypersensitivity ; Electronic Health Records ; Electronics ; Electrons ; Epidermal Necrolysis, Toxic ; Hepatitis ; Hypersensitivity ; Immunoglobulins, Intravenous ; Patient Education as Topic ; Prescriptions ; Stevens-Johnson Syndrome ; T-Lymphocytes

PURPOSE: To report three consecutive cases of methazolamide-induced Stevens-Johnson syndrome. CASE SUMMARY: We describe three patients who were all prescribed methazolamide for treatment of ophthalmologic conditions. A 29-year-old man and a 47- year-old woman were prescribed methazolamide (100 mg/day) for the treatment of central serous chorioretinopathy (CSCR). A 66-year-old woman was prescribed methazolamide (100 mg/day) for acute glaucoma of the left eye for approximately two weeks. After taking the methazolamide, three patients were showed the pururitic maculopapular rashes on the whole body and the vesicular eruptions of the oral mucosa and conjunctiva. On the basis of medication histories, characteristic skin lesions and mucosal involvement, we diagnosed all three patients with methazolamide-induced Stevens-Johnson syndrome. All three patients were hospitalized and treated with intravenous steroids and antihistamines. Two of the three cases showed conjunctival pseudomembranes. In two cases, the skin lesions worsened during the first week of treatment, and then resolved without complications over the next two to three weeks. The condition of the 47-year-old female patient deteriorated rapidly to toxic epidermal necrolysis due to sensitivity to sulfa antibiotics. HLA- A24, B59 and Cw1 were detected in all three cases. CONCLUSIONS: In 2008, domestic production of acetazolamide was halted in Korea. Because of this, methazolamide is expected to be prescribed by ophthalmologists more commonly than in previous years. Complete medical histories should be taken before prescribing methazolamide to patients. HLA typing should be conducted whenever possible to screen patients before prescription of methazolamide.
Acetazolamide ; Adult ; Aged ; Anti-Bacterial Agents ; Central Serous Chorioretinopathy ; Conjunctiva ; Epidermal Necrolysis, Toxic ; Exanthema ; Eye ; Female ; Glaucoma ; Histamine Antagonists ; Histocompatibility Testing ; HLA-B Antigens ; Humans ; Korea ; Methazolamide ; Middle Aged ; Mouth Mucosa ; Prescriptions ; Skin ; Steroids ; Stevens-Johnson Syndrome

BACKGROUND/AIMS: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are predominantly known as medication-induced diseases. However, at our institution, we have experienced more cases of non-drug-related SJS and TEN than expected. Therefore, we studied the difference between non-drug-related and drug-related SJS and TEN in terms of clinical characteristics and prognoses. METHODS: The etiologies, clinical characteristics, and treatment outcomes for 82 adult patients with SJS and TEN were retrospectively reviewed. RESULTS: A total of 71 patients (86.6%) were classified as having SJS, and the other 11 patients (13.4%) were classified as having TEN. Drug-related cases were more common (43, 52.4%) than non-drug-related cases (39, 47.6%). Anticonvulsants (12/82, 14.6%) and antibiotics (9/82, 11%) were the most common causative medications. Anemia (p = 0.017) and C-reactive protein of > or = 5 mg/dL (p = 0.026) were more common in the drug-related cases than in the non-drug-related cases. Intravenous steroid therapy was used as the main treatment regimen (70/82, 85.4%). Of the 82 patients, 8 (9.8%) died during the clinical course. A univariate analysis for mortality showed statistical significance for the following: kidney function abnormality, pneumonia, hemoglobin of < 10 g/dL, and combined underlying diseases. In a multivariate analysis, only pneumonia was statistically significant (odds ratio, 25.79; p = 0.009). CONCLUSIONS: Drugs were the most frequent cause of these diseases. However, non-drug-related causes also contributed to a significant proportion of cases. Physicians should keep this in mind when documenting patient history. In addition, early recognition and treatment may be important for better outcomes.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Chi-Square Distribution ; Epidermal Necrolysis, Toxic/diagnosis/*etiology/mortality/*therapy ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Republic of Korea ; Risk Assessment ; Risk Factors ; Stevens-Johnson Syndrome/chemically induced/diagnosis/*etiology/mortality/*therapy ; Survival Analysis ; Treatment Outcome ; Young Adult