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      Paracetamol induced Steven-Johnson syndrome: A rare case report

      case-report

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          Abstract

          In the contemporary era, use of drugs is the dominant paradigm of health care. The most quotidian drug used for fever and pain is paracetamol. Although adverse reactions to paracetamol in India are rare, at times they can cause life-threatening situations. Stevens-Johnson syndrome (SJS) is one such potentially lethal adverse drug reaction. The most reported cases of analgesic-induced SJS were due to oxicams or propionic acid derivatives. There are very few detailed reports of SJS due to the use of paracetamol. We report a case of SJS, which occurred due to the use of paracetamol. The clinical features of this condition and multidisciplinary management of the patient are described in brief.

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          Toxic epidermal necrolysis and Stevens-Johnson syndrome: does early withdrawal of causative drugs decrease the risk of death?

          H. Bocquet, J-C Roujeau, L Otero … (2000)
          Withdrawal of the drug(s) that cause severe cutaneous adverse reactions is usually recommended without proof that it alters the course of those reactions. To determine whether the timing of causative drug withdrawal is related to the prognosis of patients with toxic epidermal necrolysis (TEN) or Stevens-Johnson syndrome (SJS). A 10-year observational study (January 1, 1987, through October 30, 1997) of patients admitted to a dermatological intensive care unit, using binary logistic regression analysis. A single referral unit in a university hospital. Consecutive sample of 203 patients with TEN or SJS. Exclusion criteria included causative drug undetermined, lack of information on disease evolution, the date of causative drug(s) withdrawal, or the date when the first definite sign of TEN or SJS appeared. Death before hospital discharge. One hundred thirteen patients were included; 74 had TEN and 39 had SJS; 20 died. The drug causing TEN or SJS was withdrawn early in 64 patients and late (after the first definite sign of TEN or SJS) in 49 patients. After adjustment for confounding variables (age, maximum extent of detachment, admission year, human immunodeficiency virus status), our model showed that the earlier the causative drug was withdrawn, the better the prognosis (odds ratio, 0.69 for each day; 95% confidence interval, 0.53-0.89). Patients exposed to causative drugs with long half-lives had an increased risk of dying (odds ratio, 4.9; 95% confidence interval, 1.3-18.9). The variables did not interact. Prompt withdrawal of drug(s) that are suspected to cause SJS or TEN may decrease mortality. Prompt withdrawal of causative drugs should be a priority when blisters or erosions appear in the course of a drug eruption.
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            Toxic epidermal necrolysis and Stevens Johnson syndrome: our current understanding.

            Lars E. French (2006)
            Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN, Lyell's syndrome) are now considered to be distinct clinical entities within a spectrum of adverse cutaneous drug reactions of increasing severity based on their surface of skin detachment. Within this spectrum, SJS which can be considered as a minor form of TEN is characterized by less than 10% body surface area of skin detachment, and an average reported mortality of 1-5%, whereas TEN is characterized by more than 30% skin detachment, and an average reported mortality 25-35%. Both SJS and TEN are characterized morphologically by the rapid onset of keratinocyte cell death by apoptosis, a process that results in the separation of the epidermis from the dermis. Recent evidence is supportive of a role for inflammatory cytokines and the death receptor Fas and its ligand FasL in the pathogenesis of keratinocyte apoptosis during TEN. This Fas-mediated keratinocyte apoptosis that is the last step culminating in epidermal detachment in TEN can be inhibited in vitro by antagonistic monoclonal antibodies to Fas, and by intravenous immunoglobulins (IVIG) which have been shown to contain natural anti-Fas antibodies. Consequently, over the last few years, numerous case reports and 9 non-controlled clinical studies containing 10 or more patients have analyzed the therapeutic effect of IVIG in TEN. Taken together, although each study has its potential biases, 7 of 9 such studies point towards a benefit of IVIG used at doses greater than 2 g/kg on the mortality associated with TEN. These studies should serve as the basis for designing an appropriate prospective trial or for conducting a metaanalysis in the near future, in order to determine the therapeutic efficacy of IVIG in TEN.
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              A systematic review of the drug-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in Indian population.

              Tejas K Patel, Manish J. Barvaliya, Dineshchandra Sharma … (2024)
              Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare severe cutaneous drug reactions. No large scale epidemiological data are available for this disorder in India.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Contemp Clin Dent
                Journal ID (iso-abbrev): Contemp Clin Dent
                Journal ID (publisher-id): CCD
                Title: Contemporary Clinical Dentistry
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0976-237X
                ISSN (Electronic): 0976-2361
                Publication date (Print): September 2015
                Volume: 6
                Issue: Suppl 1
                Pages: S278-S281
                Affiliations
                [1] Department of Oral Medicine and Radiology, Jodhpur Dental College General Hospital, Jodhpur, Rajasthan, India
                [1 ] Department of Oral and Maxillofacial Pathology, Jodhpur Dental College General Hospital, Jodhpur, Rajasthan, India
                [2 ] Department of Oral Medicine and Radiology, IDS Dental college and Hospital, Bareilly, Uttar Pradesh, India
                [3 ] Department of Oral and Maxillofacial Pathology, NIMS Dental College General Hospital, Jaipur, Rajasthan, India
                Author notes
                Correspondence: Dr. Rajan Rajput, Department of Oral medicine and Radiology, Jodhpur Dental College and Hospital, Jodhpur - 342 001, Rajasthan, India. E-mail: rajan099@ 123456gmail.com
                Article
                Publisher ID: CCD-6-278
                DOI: 10.4103/0976-237X.166838
                PMC ID: 4632237
                PubMed ID: 26604588
                SO-VID: 1be1196b-9b85-4ea9-b99c-75cb210f91f4
                Copyright © Copyright: © Contemporary Clinical Dentistry
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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                Subject: Case Report

                ScienceOpen disciplines: Dentistry
                Keywords: adverse drug reaction,paracetamol,stevens-johnson syndrome
                Data availability:
                ScienceOpen disciplines: Dentistry
                Keywords: adverse drug reaction, paracetamol, stevens-johnson syndrome

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