Multiple drugs

Abstract

Toxic epidermal necrolysis, Stevens-Johnson syndrome and lack of efficacy: 9 case reports In a retrospective, single-centre, small-size study of 10 patients hospitalised between January 2014 and January 2019, 9 patients (six females patients and 3 men) aged 16–74 years were described, who developed toxic epidermal necrolysis (TEN) or StevensJohnson syndrome (SJS) during treatment with amoxicillin/clavulanic, carbamazepine, levetiracetam, paracetamol, azithromycin or ciprofloxacin. Additionally, one of them experienced lack of efficacy during treatment with immune-globulin for TEN [not all routes and indications stated; dosages and duration of treatments to reaction onsets not stated]. The patients had been receiving paracetamol [acetaminophen; 1 patient], antibiotic therapy with amoxicillin/clavulanic acid (3 patients), azithromycin (1 patient) and ciprofloxacin (1 patient) and antiepileptic therapy with carbamazepine (2 patients) and levetiracetam (1 patient). Five of the 9 patients had underlying bronchial asthma, hypertension, pulmonary embolism, cerebrovascular accident, epilepsy or hypothyroidism. Subsequently, the patients developed TEN (6 patients) and SJS (3 patients) secondary to respective ongoing treatment. Therefore, the patients were hospitalised for 4–70 days. Eight patients received unspecified treatment, and they eventually survived (alive at the time of report) with a good outcome. One woman, who was diagnosed with TEN (90% skin involvement), developed sepsis as a complication. Initially, she was admitted to a private hospital, wherein she was treated with unspecified supportive care only. After some delay, she was moved to another hospital, wherein she was treated with IV immune globulin [immunoglobulin]. However, she experienced lack of efficacy during treatment with immune globulin, and she died due to TEN and sepsis.