Toxic epidermal necrolysis secondary to Allopurinol usage

Authors

Keywords:

toxic epidermal necrolysis, toxicodermy, maculopapular lesions.

Abstract

Introduction: Toxic epidermal necrolysis is an acute, rare process with high morbidity and mortality, characterized by necrosis and detachment of the epidermis in large cutaneous areas. Its etiology is mainly due to an abnormal immune reaction to different drugs against keratinocytes. The most significant clinical findings are maculopapular lesions that evolve to vesicles, affecting mainly the oral and conjunctival mucosas, as well as the genital area, but can affect the whole body including palms and soles, involving more than 30% of the body surface.

Objective: To describe the behavior of toxic epidermal necrolysis secondary to allopurinol use.

Case presentation: A 47-year-old male patient with a history of being treated with Allopurinol was presented. After four days, he started with palpebral edema, phlyctenas on his face, macular erythematous lesions disseminated on his neck, thorax and the inguinoscrotal region, as well as erythematous-ulcerous lesions that reached 37 % of total body surface.

Conclusions: The patient developed a nontraumatic acute cutaneous failure syndrome due to toxic epidermal necrolysis associated with the allopurinol use. He responded satisfactorily to the applied therapy despite the multiple complications suffered during his evolution.

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Author Biographies

Olga Rodriguez Sánchez, Hospital Hermanos Ameijeiras

Especialista 1 er Grado en Cirugía Plástica y Caumatología. Especialista 2 do Grado en Medicina Intensiva y Emergencias. Máster en Urgencias Médicas. Profesora Auxiliar.

Teresita . Pérez Alonso, Hospital Hermanos Ameijeiras

Especialista 2 do Grado en Dermatología. Master en Enfermedades infecciosas. Profesora Auxiliar.

Dayana Espinosa Roger, Hospital Hermanos Ameijeiras

Residente de 2 do año Cirugía Plástica y Caumatología.

Andrés . Ramón Gómez Delgado, Hospital Hermanos Ameijeiras

Residente de 1 er año Cirugía Plástica y Caumatología.

Roger Peinado Medina, Hospital Hermanos Ameijeiras

Residente de 2do año Cirugía Plástica y Caumatología.

References

Mayorga JS, Jiménez AV, Sánchez AC. Síndrome de Stevens-Johnson y Necrólisis Epidérmica Tóxica, un reto diagnóstico y terapéutico. Rev Med Sinergia. 2020;5(1): 308.

Frey N, Jossi J, Bodmer M, Bircher A, Jick SS, Meier CR. The Epidemiology of Stevens Johnson Syndrome and Toxic Epidermal Necrolysis in the UK. J Invest Dermatol. 2017;6;137(6):1240-7. DOI: https://doi.org/10.1016/j.jid.2017.01.031

Hasegawa A, Abe R. Recent advances in managing and understanding Stevens-Johnson syndrome and toxic epidermal necrolysis. F1000Res. 2020;9:F1000. DOI: https://doi.org/10.12688/f1000research.24748.1

Arora R, Pande RK, Panwar S, Gupta V. Drug-related Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Review. Indian J Crit Care Med. 2021;25(5):575-9. DOI: https://doi.org/10.5005/jp-journals-10071-23826

Ueta M. Pathogenesis of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis with Severe Ocular Complications. Front Med (Lausanne). 2021;8:651247. DOI: https://doi.org/10.3389/fmed.2021.651247

Hsieh MH, Watanabe T, Aihara M. Recent Dermatological Treatments for Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Japan. Front Med (Lausanne). 2021;8:636924. DOI: https://doi.org/10.3389/fmed.2021.636924

White KD, Abe R, Ardern-Jones M, Beachkofsky T, Bouchard C, Carleton B, et al. SJS/TEN: Building Multidisciplinary Networks to Drive Science and Translation. J Allerg Clinic Immun. 2018 01;6(1):3869. DOI: https://doi.org/10.1016/j.jaip.2017.11.023

Patel TK, Patel PB, Thakkar S. Comparison of effectiveness of interventions in reducing mortality in patients of toxic epidermal necrolysis: A network meta-analysis. Indian J Dermatol Venereol Leprol. 2021;87(5):628-44. DOI: https://doi.org/10.25259/IJDVL_605_19

Wang Y, Chen C, Tassaneeyakul W, Saito Y, Aihara M, Choon SE, et al. The Medication Risk of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Asians: The Major Drug Causality and Comparison with the US FDA Label. Clinical Pharmacology & Therapeutics. 2018;105(1):112-20. DOI: https://doi.org/10.1002/cpt.1071

Arellano J, Álvarez D, Salinas MP, Molina I. Incidencia de síndrome de Stevens-Johnson y necrólisis epidérmica tóxica en Chile años 2001-2015 y su asociación con la latitud. Rev Med Chil. 2020;148(7):915-20. Spanish. DOI: https://doi.org/10.4067/S0034-98872020000700915

Stern RS, Divito SJ. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Associations, Outcomes, and Pathobiology, Thirty Years of Progress but Still Much to Be Done. J Invest Dermat. 2017;137(5):1004-8. DOI: https://doi.org/10.1016/j.jid.2017.01.003

Kuijper EC, French LE, Tensen CP, Vermeer MH, Bouwes Bavinck JN. Clinical and pathogenic aspects of the severe cutaneous adverse reaction epidermal necrolysis (EN). J Eur Acad Dermatol Venereol. 2020;34(9):1957-71. DOI: https://doi.org/10.1111/jdv.16339

González-Herrada C, Rodríguez-Martín S, Cachafeiro L, Lerma V, González O, Lorente JA, et al. Cyclosporine Use in Epidermal Necrolysis Is Associated with an Important Mortality Reduction: Evidence from Three Different Approaches. J Invest Dermat. 2017;137(10):20922100. DOI: https://doi.org/10.1016/j.jid.2017.05.022

Kara A, Devrim İ, Çağlar İ, Bayram N, Kundak S, Apa H. Stevens-Johnson syndrome and toxic epidermal necrolysis: a report of six cases. Turk J Pediatr. 2019;61(4):538-43. DOI: https://doi.org/10.24953/turkjped.2019.04.010

Published

2022-10-09

How to Cite

1.
Rodriguez Sánchez O, Pérez Alonso T ., Espinosa Roger D, Gómez Delgado A . R, Peinado Medina R. Toxic epidermal necrolysis secondary to Allopurinol usage. Acta Médica [Internet]. 2022 Oct. 9 [cited 2025 Aug. 26];23(3). Available from: https://revactamedica.sld.cu/index.php/act/article/view/329

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Section

Presentación de caso