Multiple drugs

Abstract

Stevens-Johnson syndrome/toxic epidermal necrolysis: 6 case reports In a study of 124 patients who had been admitted to a hospital in China between January 2000 to June 2019, 6 patients (4 males and 2 females) aged 12–69 years were described, who developed Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) overlap (1 patient), SJS (2 patients) or TEN (3 patients) following treatment with allopurinol, aminophenazone, carbamazepine, cefoperazone, kitasamycin, nimesulide, paracetamol or unspecified sulfonamides [dosages, routes, indications and times to reactions onsets not stated]. A 33-year-old woman (case 1 from Table I of the article), who developed SJS/TEN overlap following treatment with nimesulide and unspecified sulfonamides: The woman, who had no prior biliary history, was admitted to a hospital in China. She was diagnosed with SJS/TEN, and the culprit drugs were reported to be nimesulide and unspecified sulfonamides. Laboratory tests revealed increased levels of lipase, amylase, ALT, AST, alkaline phosphatase (ALP) with positive antinuclear and anti-Ro/SSA antibodies and decreased level of albumin. An abdominal CT or ultrasonographic scan showed diffuse enlargement of the pancreas. Based upon the results of the investigations, a diagnosis of acute pancreatitis secondary to SJS/TEN overlap was made. She was therefore treated with low-fat liquid diet, octreotide [octreotide acetate], unspecified steroids and etanercept, which resulted in resolution of the SJS/ TEN. On day 17, she was discharged from the hospital. A 52-year-old man (case 4 from Table I of the article), who developed TEN following treatment with aminophenazone [aminopyrine] and cefoperazone: The man, who had no prior biliary history, was admitted to a hospital in China. He was diagnosed with TEN, and the culprit drugs were reported to be aminophenazone and cefoperazone. Laboratory tests revealed increased levels of lipase, amylase, ALT, AST, ALP and decreased level of albumin. An abdominal CT or ultrasonographic scan showed unclear border of the pancreas and pancreatic duct dilatation. Based upon the results of the investigations, a diagnosis of acute pancreatitis secondary to TEN was made. He was therefore treated with somatostatin and unspecified steroids along with fasting which resulted in resolution of the TEN. On day 18, he was discharged from hospital. A 69-year-old man (case 5 from Table I of the article), who developed TEN following treatment with allopurinol: The man, who had a prior biliary history, was admitted to a hospital in China. He was diagnosed with TEN, and the culprit drug was reported to be allopurinol. Laboratory tests revealed increased levels of lipase, amylase, ALT, AST, creatinine and decreased level of albumin. An abdominal CT or ultrasonographic scan showed gallstones in the gallbladder. Based upon the results of the investigations, a diagnosis of acute pancreatitis secondary to TEN was made. He was therefore treated with somatostatin and unspecified steroids along with fasting which resulted in resolution of the TEN. On day 25, he was discharged from hospital. A 59-year-old woman (case 6 from Table I of the article), who developed TEN following treatment with carbamazepine: The woman, who had no prior biliary history, was admitted to a hospital in China. She was diagnosed with TEN, and the culprit drug was reported to be carbamazepine. Laboratory tests revealed increased levels of lipase, amylase, ALT, AST and alkaline phosphates with positive antinuclear and negative anti-Ro/SSA antibodies and decreased level of albumin and creatinine. An abdominal CT or ultrasonographic scan showed no evidence of pancreatic disease. Based upon the results of the investigations, a diagnosis of acute pancreatitis secondary to TEN was made. She was therefore treated with octreotide [octreotide acetate], IV immune globulin and unspecified steroids along with fasting which resulted in resolution of TEN. On day 14, she was discharged from hospital. A 12-year-old boy (case 8 from Table I of the article), who developed SJS following treatment with paracetamol [acetaminophen] and kitasamycin: The boy, who had no prior biliary history, was admitted to a hospital in China. He was diagnosed with SJS, and the culprit drugs were reported to be paracetamol and kitasamycin. Laboratory tests revealed increased levels of lipase, amylase, ALT, AST, alkaline phosphates with negative antinuclear antibody and decreased level of albumin. An abdominal CT or ultrasonographic scan showed diffuse enlargement of the pancreas. Based upon the results of the investigations, a diagnosis of acute pancreatitis secondary to SJS was made. He was therefore treated with somatostatin, unspecified antibiotics and steroids with fasting. On day 30, he was discharged from hospital. However, he exhibited chronic hyperamylasemia thereafter [outcomes not stated]. A 31-year-old man (case 9 from Table I of the article), who developed SJS following treatment with paracetamol [acetaminophen] and unspecified sulfonamides: The man, who had no prior biliary history, was admitted to a hospital in China. He was diagnosed with SJS, and the culprit drugs were reported to be paracetamol and unspecified sulfonamides. Laboratory tests revealed increased levels of lipase, amylase, ALT, AST, alkaline phosphates, creatinine with negative antinuclear and anti-Ro/SSA antibodies and decreased level of albumin. An abdominal CT or ultrasonographic scan showed no evidence of pancreatic disease. Based upon the results of the investigations, a diagnosis of acute pancreatitis secondary to SJS was made. He was therefore treated with octreotide [octreotide acetate], unspecified steroids and IV immune globulin with fasting which resulted in resolution of SJS. On day 30, he was discharged from hospital.