Pancytopenia in a Patient with Stevens-Johnson Syndrome: A Case Report with Literature Review

Malik, Mustafa Nadeem; Ullah, Ateeqa Mujeeb; Ahmad, Muhaddis Ejaz; Riaz, Rabia; Syed, Tariq Iqtidar Sadiq

doi:10.7759/cureus.4702

Cited by 2 publications

(5 citation statements)

References 20 publications

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“…Recent reports have observed certain rare causes of pancytopenia that include breast carcinoma, myxedema coma, or Stevens-Johnson syndrome. [232425] Although no such cause was reported in the present study, it is necessary that clinicians and the pathologists should be aware of such rare causes of pancytopenia. Similar to our study, Le Clef et al .…”

Section: Discussionmentioning

confidence: 66%

Clinico-hematological study of pancytopenia: A single-center experience from north Himalayan region of India

Chandra

Gupta

Nath

et al. 2019

J Family Med Prim Care

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Background:Pancytopenia, an important hematological presentation is associated with different causes, which may vary in different regions. Uttarakhand, a north Himalayan state of India lacks studies of pancytopenia and the prevalent causes present in this region. Therefore, the present study was conducted to study the clinico-hematological profile of pancytopenia in a tertiary care center in the Uttarakhand, a north Himalayan state of India. It was also intended to study if these causes showed any variation from other studies done in different regions of India.Materials and Methods:The present observational study was conducted in a tertiary care institute situated in Uttarakhand state of India over a period of 1 year and 8 month from June 2017 to Feb 2019 including all the cases of pancytopenia.Results:The most common cause of pancytopenia was megaloblastic anemia (25%), followed by aleukemic leukemia and hypoplastic/aplastic anemia (19.1% each). Visceral leishmaniasis also constituted an important cause of pancytopenia in this study (11.7%).Conclusion:The study concludes that megaloblastic anemia and aleukemic leukemia are the most common cause of pancytopenia. Although leishmaniasis is considered to be non-endemic in this region, it constitutes an important cause of pancytopenia here. The clinicians, especially the physicians practicing the primary care and pathologists, should be aware of the different causes of pancytopenia present in this Himalayan region of India; therefore, delay in diagnosis can be prevented along with unnecessary investigations.

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Section: Discussionmentioning

confidence: 66%

Clinico-hematological study of pancytopenia: A single-center experience from north Himalayan region of India

Chandra

Gupta

Nath

et al. 2019

J Family Med Prim Care

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“…Common hematological manifestation of SJS include anemia, leukopenia, and neutropenia but pancytopenia is an exceedingly rare occurrence 5 , 6 . Pancytopenia was noted with a platelet count of 81 000/mm 3 , while the red blood cell (RBC) count was 2.5 million/mm 3 and the white blood cell (WBC) count was 3800/mm 3 in our study.…”

Section: Discussionmentioning

confidence: 99%

“…In some studies, discontinuation of allopurinol and management with steroid and prophylactic antibiotics have been effective 6 , 12 . Similar to these findings, our case improved after discontinuing allopurinol and initiating IV steroid and prophylactic antibiotics.…”

Section: Discussionmentioning

confidence: 99%

“…Similar to these findings, our case improved after discontinuing allopurinol and initiating IV steroid and prophylactic antibiotics. In previous studies, pancytopenia associated with SJS was managed with red blood cell transfusion and fresh frozen plasma transfusion 6 . Unlike managing pancytopenia with blood cell or plasma or platelet concentrate transfusion, pancytopenia was conservatively managed in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Allopurinol is frequently associated with SJS or toxic epidermal necrolysis (TEN) 4 . Hematological abnormalities such as pancytopenia are seldom reported in the rare condition SJS 5 , 6 . We present a 61-year-old with SJS and pancytopenia.…”

Section: Introductionmentioning

confidence: 99%

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Stevens-Johnson syndrome associated with pancytopenia: A case report

Prasai,

Shakya,

Singh

et al. 2024

Annals of Medicine &Amp; Surgery

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Introduction and Importance: Stevens-Johnson Syndrome (SJS) is a rare and unusual hypersensitivity reaction to certain drugs like allopurinol, commonly used for treating gout. SJS is recognized by extensive necrosis and detachment of skin and mucus membranes. Pancytopenia, characterized by decreased levels of red blood cells, white blood cells and platelets, is an exceedingly rare occurrence in the rare disorder SJS. Case presentation: We present a 61-year-old male who exhibited symptoms of fever and rash for 5 days accompanied by pancytopenia and liver injury. Clinical Discussion: The abdomen and bilateral lower extremities exhibited several well-defined dusky-colored hyperpigmented macular lesions. Initially, these lesions were small, tender, erythematous, and raised, later transitioning to a dark red. Multiple distinct ulcerations were present on the lips and buccal cavity. Additionally, there was denudation of the skin with bleeding observed between the toes of both legs. The causality was assessed as a definite adverse drug reaction according to the Naranjo and ALDEN algorithm. The patient received treatment consisting of intravenous steroid along with prophylactics antibiotics. The individual’s pancytopenia was resolved without requiring any blood cells or plasma or platelet concentrate transfusion. Conclusion: The exact pathophysiology of SJS associated with pancytopenia has not yet been fully elucidated. Our study hypothesized that the cause of pancytopenia in SJS could be either the direct cytotoxicity of drugs or immune mediated damage to the bone marrow cells. Additional studies are necessary to establish the precise pathophysiology of the condition. Moreover, our study also indicates that pancytopenia can resolve in SJS without the need for blood cells or plasma or platelet concentrate transfusion. Once more, further studies are required to establish precise management strategies for managing SJS associated with pancytopenia.

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Pancytopenia in a Patient with Stevens-Johnson Syndrome: A Case Report with Literature Review

Cited by 2 publications

References 20 publications

Clinico-hematological study of pancytopenia: A single-center experience from north Himalayan region of India

Clinico-hematological study of pancytopenia: A single-center experience from north Himalayan region of India

Stevens-Johnson syndrome associated with pancytopenia: A case report

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