Nimesulide induced toxic epidermal necrolysis: a rare case report

Abstract

Adverse drug reactions to the prescribed medicines are the major obstacles in continuation of drug treatment. Nimesulide, a selective cyclo-oxygenase (COX-2) inhibitor was first launched in Italy in 1985 and subsequently marketed in more than 50 countries including India. Due to its better and faster antipyretic action, it has gained popularity among physicians and paediatricians. Here, we report a case of 60 years old male patient who developed toxic epidermal necrolysis (TEN) following ingestion of tablet nimesulide. The patient was managed with parenteral corticosteroids, antibiotics, emollients, anti-fungal and supportive care. This case highlights the importance of nimesulide and other NSAIDs as possible cause of TEN. Nimesulide has never been approved in countries like USA, Canada, Britain, New Zealand, Australia. But in India it is available as over the counter drug and is used for various indications like fever, myalgia, arthralgia. Therefore, the drugs which are banned outside India should be used with caution and medical practitioners should report all the adverse drug reactions to such drugs.

A Case report on Toxic Epidermal Necrolysis

“…Newer drugs that have been associated with SJS and TEN include nevirapine, lamotrigine, sertraline, pantoprazole, and tramadol. 5 Bastuji-Garin et al (2000), developed the SCORTEN score, a recognized and validate measure of disease se-verity, with the following seven clinical criteria (Table 1). In our patient the SCORTEN was 3, indicating a high risk of mortality (35.3%) (Table 2).…”

A case of nimesulide induced toxic epidermal necrolysis

“…There have been previous case reports of TEN caused by nimesulide showing increase in risk of TEN with nimesulide use. 3,10,11 Rechallenge was not done as it would not be clinically justifiable. Increased usage of nimesulide by prescription as well as OTC has led to increase in occurrence of side effects and adverse reactions.…”