Multiple drugs

Abstract

Stevens Johnson syndrome and toxic epidermal necrolysis: 11 case reports In a single centre retrospective study of 11 patients [6 boys and 5 girls] aged 2.3–15 years conducted between 2010 and 2015, who developed Stevens Johnson syndrome (SJS) (2 patients), toxic epidermal necrolysis (TEN) (5 patients) and SJS/TEN (4 patients) during treatment with lamotrigine, valproic acid, ceftriaxone, cefuroxime, paracetamol, ibuprofen, amoxicillin/clavulanic acid, clarithromycin, cefalexin, phenytoin, guaifenesin/mepyramine/paracetamol/ phenylephrine or herbal medicines. The patients had been receiving treatment with lamotrigine and valproic acid (n=3), ceftriaxone and cefuroxime (n=1), paracetamol and ibuprofen (n=1), valproic acid, amoxicillin/ clavulanic acid [amoxicillin/clavulanates], clarithromycin and ibuprofen (n=1), amoxicillin/clavulanic acid, clarithromycin and ibuprofen (n=1), cefalexin [cephalexin] and ceftriaxone (n=1), amoxicillin/clavulanic acid (n=1), phenytoin and amoxicillin/clavulanic acid (n=1) and cold syrup containing guaifenesin/mepyramine/paracetamol/phenylephrine [paracetamol, guaifenesin, pyrilamine maleate, phenylephrine] and herbal medicines [Herbal mixture] containing anise extract, mint leaf extract, chicory root extract, fennel fruit extract and grapefruit extract (n=1) [dosages and routes not stated; not all indications stated]. After 2–44 days of treatments, all the patients developed maculopapular rashes and mucositis in the mouth and eye. Pathological examination showed keratinocyte damage, vacuolisation and apoptosis in the epidermis basal layer. Maculopapular lesions were spread over the face, arms, trunk and legs. Subsequently, all the patients were hospitalised and diagnosed with SJS (n=2), TEN (n=5) and in some patients SJS was later transitioned to TEN (n=4). All the patients were treated with unspecified first generation H1 antihistaminic drugs and methylprednisolone. Out of these 11 patients, eight patients were also treated with immune globulin, four patients were also treated with unspecified antibiotics, three patients were also treated with unspecified anti-fungal drugs, one patient also treated with unspecified antiviral, one patient also treated with ciclosporin and erythrocyte transfusion, and two patients were also treated with albumin. Subsequently, the lesions had recovered in all patients. Author comment: Stevens Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are. . .delayed drug hypersensitivity reactions. [R]egarding the development of SJS and TEN, anticonvulsants (. . .lamotrigine. . .valproic acid), antibiotics (. . .penicillins, cephalosporins), non-steroidal antiinflammatory drugs (NSAIDs) and acetaminophen drugs. . .carry a risk. In our study. . .drugs associated with SJS, TEN and SJS/TEN. . .were evaluated anticonvulsants. . .and antibiotics.