Stevens-Johnson syndrome (SJS), also known as the multifactorial erythematous drug eruption, is a class of adverse reactions of the skin and mucous membranes primarily caused by drug allergy often involving the oral cavity, eyes, and external genital mucosa, generally accompanied by fever, and can be life-threatening in severe cases. In February 2022, the Department of Stomatology, the First Affiliated Hospital of Zhengzhou University admitted a patient with huge inflammatory hyperplasia of bilateral lingual margins secondary to SJS. Upon admission, no other obvious symptoms were observed except for tongue hyperplasia. The patient suffered from a severe adverse drug reaction caused by acetaminophen 2 months ago and was complicated by liver dysfunction and pulmonary infection. After 1 month of treatment and rehabilitation, he developed a secondary tongue mass and was subsequently admitted to Dept. of Oral and Maxillofacial Surgery Ward 2, the First Affiliated Hospital of Zhengzhou University. After completing the examination, the tongue mass was surgically removed. After a follow-up of 11 months, the patient's condition was satisfactory and no temporary discomfort was observed. The case of tongue mass secondary to SJS is extremely rare. If a stomatologist encounters a similar case, we should carefully inquire about the drug allergy history and recent medication history, and be alert to whether or not they had adverse drug reactions recently.
Male ; Humans ; Stevens-Johnson Syndrome/drug therapy* ; Hyperplasia/pathology* ; Skin ; Drug Hypersensitivity/pathology* ; Tongue

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, but life-threatening, severe cutaneous adverse reactions most frequently caused by exposure to drugs. Several reports have associated the use of acetaminophen with the risk of SJS or TEN. A typical interval from the beginning of drug therapy to the onset of an adverse reaction is 1-3 weeks. A 43-year-old woman and a 60-year-old man developed skin lesions within 3 days after administration of acetaminophen for a 3-day period. Rapid identification of the symptoms of SJS and TEN caused by ingestion of acetaminophen enabled prompt withdrawal of the culprit drug. After administration of intravenous immunoglobulin G, both patients recovered fully and were discharged. These two cases of rapidly developed SJS/TEN after ingestion of acetaminophen highlight the possibility that these complications can develop within only a few days following ingestion of over-the-counter medications such as acetaminophen.
Acetaminophen ; Adult ; Drug Therapy ; Eating ; Female ; Humans ; Hypersensitivity ; Immunoglobulin G ; Middle Aged ; Skin ; Stevens-Johnson Syndrome

Cytomegalovirus(CMV) colitis is an important opportunistic infection in immunocompromised individuals. The clinical symptoms are abdominal pain, diarrhea, colonic hemorrhage and perforation. The endoscopic appearance shows three characteristic features with focal or diffuse inflammatory changes, submucosal hemorrhagic spots, and well demarcated ulcers. We experienced a case of CMV colitis in an 8-year-old girl presented with Stevens-Johnson syndrome, vanishing bile duct syndrome and infection-associated hemophagocytic histiocytosis, which developed during chemotherapy with etoposide and dexamethasone for hemophagocytic syndrome. The impaired immunity caused by chemotherapy is the most likely possible cause of CMV colitis in this case. We confirmed this case by endoscopic findings, the presence of cytomegalic cells on mucosal biopsy specimens, immunohistochemistry with monoclonal antibody to CMV antigen, and serologic study, and report with a brief review of the literature.
Abdominal Pain ; Bile Ducts ; Biopsy ; Child ; Colitis* ; Colon ; Cytomegalovirus* ; Dexamethasone ; Diarrhea ; Drug Therapy ; Etoposide ; Female ; Hemorrhage ; Histiocytosis ; Humans ; Immunohistochemistry ; Lymphohistiocytosis, Hemophagocytic* ; Opportunistic Infections ; Stevens-Johnson Syndrome ; Ulcer

Anti-Bacterial Agents ; adverse effects ; Humans ; Immunoglobulins, Intravenous ; therapeutic use ; Immunologic Factors ; therapeutic use ; Levofloxacin ; Ofloxacin ; adverse effects ; Stevens-Johnson Syndrome ; drug therapy ; etiology

Aged ; Antitubercular Agents ; adverse effects ; therapeutic use ; Heart Failure ; Humans ; Hypothermia ; diagnosis ; etiology ; Stevens-Johnson Syndrome ; diagnosis ; etiology ; Tuberculosis ; drug therapy

Aged ; Bone Density Conservation Agents ; adverse effects ; Female ; Humans ; Organometallic Compounds ; adverse effects ; Osteoporosis, Postmenopausal ; drug therapy ; Stevens-Johnson Syndrome ; chemically induced ; diagnosis ; physiopathology ; Thiophenes ; adverse effects

Lamotrigine is an anticonvulsant drug used to treat partial and generalized seizure disorders. Hypersensitivity to lamotrigine usually causes mild symptoms such as fever, rash, and slight invasion of internal organs. However, a 33-year-old male patient who was admitted with Stevens-Johnson syndrome after taking lamotrigine for 15 days experienced hepatic failure and died 5 days after admission. This case demonstrates the importance of realizing that lamotrigine can lead to fatal hepatic failure, and that tests for the normal liver function should be performed when administering lamotrigine.
Adult ; Alanine Transaminase/blood ; Anticonvulsants/*adverse effects/therapeutic use ; Aspartate Aminotransferases/blood ; Drug Hypersensitivity/complications/*diagnosis ; Humans ; Liver/enzymology/metabolism ; Liver Failure/*etiology ; Male ; Stevens-Johnson Syndrome/diagnosis/drug therapy ; Triazines/*adverse effects/therapeutic use

The prophylactic use of phenytoin during and after brain surgery and cranial irradiation is a common measure in brain tumor therapy. Phenytoin has been associated with variety of adverse skin reactions including urticaria, erythroderma, erythema multiforme (EM), Stevens-Johnson syndrome, and toxic epidermal necrolysis. EM associated with phenytoin and cranial radiation therapy (EMPACT) is a rare specific entity among patients with brain tumors receiving radiation therapy while on prophylactic anti-convulsive therapy. Herein we report a 41-year-old female patient with left temporal glial tumor who underwent surgery and then received whole brain radiation therapy and chemotherapy. After 24 days of continous prophylactic phenytoin therapy the patient developed minor skin reactions and 2 days later the patient returned with generalized erythamatous and itchy maculopapuler rash involving neck, chest, face, trunk, extremities. There was significant periorbital and perioral edema. Painful mucosal lesions consisting of oral and platal erosions also occurred and prevented oral intake significantly. Phenytoin was discontinued gradually. Systemic admistration of corticosteroids combined with topical usage of steroids for oral lesions resulted in complete resolution of eruptions in 3 weeks. All cutaneous lesions in patients with phenytoin usage with the radiotherapy must be evoluated with suspicion for EM.
Adrenal Cortex Hormones ; Adult ; Brain ; Brain Neoplasms ; Cranial Irradiation ; Dermatitis, Exfoliative ; Drug Therapy ; Edema ; Erythema Multiforme* ; Erythema* ; Exanthema ; Extremities ; Female ; Humans ; Neck ; Phenytoin* ; Radiotherapy ; Skin ; Steroids ; Stevens-Johnson Syndrome ; Thorax ; Urticaria

BACKGROUNDStevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening diseases with high mortality rates. This study was designed to analyze the pathogenic factors, clinical manifestations, complications, treatment, and prognosis of SJS/TEN and to explore the differences between surviving and deceased patients.

METHODSSJS/TEN patients admitted to Beijing Friendship Hospital from January 2006 to December 2015 were included in the study. Patients' data were retrospectively analyzed. Comparative studies were performed on the survival group and the deceased group, and Fisher's exact probability test was used for statistical analysis.

RESULTSAmong the 88 patients included, 40 (45.5%) were male with a mean age of 45 ± 18 years. Forty-eight (54.5%) had SJS, 34 (38.6%) had SJS/TEN, and 6 (6.8%) had TEN. Fifty-three (60.2%) cases were caused by medications, mainly antibiotics (n = 24) followed by traditional Chinese medicines (n = 7). Forty-two cases (47.7%) developed visceral damage. Eighty-two patients improved or recovered and were discharged from hospital, and six patients died. Comparative studies on the survival group and the deceased group showed that the presence of malignant tumor ( χ2 = 27.969,P < 0.001), connective tissue diseases ( χ2 = 9.187, P= 0.002), previous abnormal liver/kidney functions ( χ2 = 6.006, P= 0.014), heart rate >100 times/min ( χ2 = 6.347, P= 0.012), detached skin area >20% ( χ2 = 5.594, P= 0.018), concurrent mucosal involvement at the mouth, eyes, and external genitals ( χ2 = 4.945, P= 0.026), subsequent accompanying liver/kidney damage ( χ2 = 11.839, P= 0.001, and χ2 = 36.302,P < 0.001, respectively), and SCORTEN score >2 ( χ2 = 37.148,P < 0.001) increased the risk of death.

CONCLUSIONSSJS/TEN is mainly caused by medications, and nearly half of patients develop visceral damage. Multiple factors increase the mortality risk.

Adult ; Anti-Bacterial Agents ; therapeutic use ; Connective Tissue Diseases ; metabolism ; pathology ; Eye ; pathology ; Female ; Genitalia ; pathology ; Humans ; Kidney ; metabolism ; pathology ; Liver ; metabolism ; pathology ; Male ; Middle Aged ; Mouth ; pathology ; Retrospective Studies ; Skin ; metabolism ; pathology ; Stevens-Johnson Syndrome ; drug therapy ; metabolism ; pathology

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions (SCAR) to drugs which are associated with significant morbidity and mortality. High risk drugs in Asia are similar to those reported worldwide. Human leukocyte antigen (HLA)-related risk alleles for carbamazepine and allopurinol SCAR are unique to Asians. Although prognostic scoring systems like the SCORTEN have been used for more than a decade, pitfalls and caveats need to be recognized, in particular in patients with multiple medical co-morbidities and systemic features in SJS/TEN. In centres without a tertiary Burns Centre, SJS/TEN patients can still be managed successfully in general and dermatology wards with well-executed supportive/nursing care. Controversy remains regarding the effectiveness of immunomodulation in reducing SJS/TEN morbidity, mortality and hastening re-epithelialization. Despite paucity of robust evidence, intravenous immunoglobulins and ciclosporin remain the most commonly used modalities worldwide. Acute and long-term ocular effects are an important source of morbidity for which emerging ophthalmic therapies appear promising. Quality of life issues have now become an important outcome in patients with SJS/TEN as they often impact survivors' future attitudes towards pharmacotherapy. Even though pharmacogenetic testing for high-risk drugs appears to be the panacea for preventing carbamazepine- and allopurinol-induced SJS/TEN in ethnic Asians, many issues remain before health regulators in our region can conclusively determine whether testing should be made mandatory or highly recommended as standard of care.
Alleles ; Allopurinol ; Asia ; Asian Continental Ancestry Group ; Burns ; Carbamazepine ; Cicatrix ; Cyclosporine ; Dermatology ; Drug Therapy ; HLA Antigens ; Humans ; Immunoglobulins, Intravenous ; Immunomodulation ; Leukocytes ; Mortality ; Pharmacogenetics ; Quality of Life ; Re-Epithelialization ; Standard of Care ; Stevens-Johnson Syndrome