Severe Cutaneous Adverse Reactions: A Single-Center Retrospective Study of 173 Patients in China

Xu, Zhongyi; Shen, Jie; Yang, Yiwen; Yuan, Ruoyue; Xiang, Leihong; Zhang, Chengfeng

doi:10.5021/ad.2019.31.5.545

Cited by 5 publications

(7 citation statements)

References 41 publications

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“…The remaining 4467 studies were screened for title, abstract, and full text, and 64 potentially relevant studies were identified. Of the 64 studies that underwent data extraction, 3 studies described the same study population and were excluded from the meta-analysis. Furthermore, there were 23 studies that did not count the SJS/TEN associations at the patient level and thus were excluded.…”

Section: Resultsmentioning

confidence: 99%

Worldwide Prevalence of Antibiotic-Associated Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

2023

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ImportanceAntibiotics are an important risk for Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN), which are the most severe types of drug hypersensitivity reaction with a mortality rate up to 50%. To our knowledge, no global systematic review has described antibiotic-associated SJS/TEN.ObjectiveTo evaluate the prevalence of antibiotics associated with SJS/TEN worldwide.Data SourcesThe MEDLINE and Embase databases were searched for experimental and observational studies that described SJS/TEN risks since database inception to February 22, 2022.Study SelectionIncluded studies adequately described SJS/TEN origins and specified the antibiotics associated with SJS/TEN.Data Extraction and SynthesisTwo reviewers (E.Y.L. and C.K.) independently selected the studies, extracted the data, and assessed the risk of bias. A meta-analysis using a random-effects model was performed in the studies that described patient-level associations. Subgroup analyses were performed to explore the heterogeneity. The risk of bias was assessed using the Joanna Briggs Institute checklist, and the certainty of evidence was rated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.Main Outcomes and MeasuresPrevalence of antibiotic-associated SJS/TEN was presented as pooled proportions with 95% CIs.ResultsAmong the 64 studies included in the systematic review, there were 38 studies that described patient-level associations; the meta-analysis included these 38 studies with 2917 patients to determine the prevalence of single antibiotics associated with SJS/TEN. The pooled proportion of antibiotics associated with SJS/TEN was 28% (95% CI, 24%-33%), with moderate certainty of evidence. Among antibiotic-associated SJS/TEN, the sulfonamide class was associated with 32% (95% CI, 22%-44%) of cases, followed by penicillins (22%; 95% CI, 17%-28%), cephalosporins (11%; 95% CI, 6%-17%), fluoroquinolones (4%; 95% CI, 1%-7%), and macrolides (2%; 95% CI, 1%-5%). There was a statistically significant heterogeneity in the meta-analysis, which could be partially explained in the subgroup analysis by continents. The overall risk of bias was low using the Joanna Briggs Institute checklist for case series.Conclusion and RelevanceIn this systematic review and meta-analysis of all case series, antibiotics were associated with more than one-quarter of SJS/TEN cases described worldwide, and sulfonamide antibiotics remained the most important association. These findings highlight the importance of antibiotic stewardship, clinician education and awareness, and weighing the risk-benefit assessment of antibiotic choice and duration.

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Section: Resultsmentioning

confidence: 99%

Worldwide Prevalence of Antibiotic-Associated Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

2023

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“…An Indian study showed that SJS/TEN and DRESS were the most and least common, respectively [ 7 ]. In Asia, SJS/TEN appears to be the most common followed by DRESS and AGEP [ 16 , 17 ]. The predominance of DRESS in our study can be attributed to genetic differences.…”

Section: Discussionmentioning

confidence: 99%

Severe Cutaneous Adverse Drug Reactions at a Tertiary Care Center in Saudi Arabia

AlJasser

2023

Dermatology Research and Practice

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Background. Severe cutaneous adverse drug reactions (SCARs), although rare, are known to be associated with significant morbidity and mortality. SCARs include drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), and acute generalized exanthematous pustulosis (AGEP). Studies on SCARs are limited in Saudi Arabia. This study aims to characterize SCARs at a tertiary care center in Saudi Arabia. Methods. A cross-sectional study was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia. All inpatient and emergency department consultations to dermatology were electronically reviewed during the period from January 2016 to December 2020. All patients who developed an adverse cutaneous drug reaction were enrolled. Detailed analysis was performed only for SCARs. The culprit medication was determined based on the latency period, history of previous intake of the medication, and drug notoriety. Results. There were 3050 hospital consultations to dermatology during the study period. Cutaneous adverse drug reactions constituted 253 (8.3%) cases. A total of 41 patients with SCARs were identified, accounting for 16.2% of all cutaneous drug reactions. Antibiotics and anticonvulsants were the most common causative drug groups accounting for 28 (68.3%) and 9 (22%) cases, respectively. DRESS was the most common SCAR. The latency period was the longest for DRESS and shortest for AGEP. Vancomycin was responsible for approximately a third of DRESS cases. Piperacillin/tazobactam was the most common cause for SJS/TEN and AGEP. The majority of drugs causing AGEP were antibiotics. The mortality rate was the highest in SJS/TEN (5/11 (45.5%)), followed by DRESS (1/23 (4.4%)) and AGEP (1/7 (14.3%)). Conclusion. SCARs are rare in Saudis. DRESS appears to be the most common SCAR in our region. Vancomycin is responsible for most cases of DRESS. SJS/TEN had the highest mortality rate. More studies are required to further characterize SCARs in Saudi Arabia and Arabian Gulf countries. More importantly, thorough studies of HLA associations and lymphocyte transformation tests among Arabs with SCARs are likely to further improve patient care in the Arabian Gulf region.

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“…Renal dysfunction related to DRESS has been reported to happen in 10% to 64% of patients and is usually attributed to AIN 2,5,7,11 . Allopurinol‐induced DRESS is more likely to suffer from renal injury than other drugs.…”

Section: Discussionmentioning

confidence: 99%

“…1,5,7,9,10 Renal dysfunction related to DRESS has been reported to happen in 10% to 64% of patients and is usually attributed to AIN. 2,5,7,11 Allopurinol-induced DRESS is more likely to suffer from renal injury than other drugs. In our study, serum creatinine elevation was seen in 71.2 % of patients, and up to 21.2% of patients underwent either short-or long-term dialysis.…”

Section: Discussionmentioning

confidence: 99%

Clinical features, treatment outcomes and prognostic factors of allopurinol‐induced DRESS in 52 patients

Liu

Zhao

Chen

2022

Clinical Pharmacy Therapeu

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What is Known and Objective: Allopurinol-induced drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but serious and potentially life-threatening drug hypersensitivity syndrome. In this study, we aimed to investigate the clinical features, treatment outcomes, and prognostic factors of allopurinol-induced DRESS.Methods: Case reports of allopurinol-induced DRESS published by China from January 2000 to August 2021 were retrieved from CNKI, Wan Fang, VIP, and PubMed databases for analysis.Results and Discussion: This study included 52 patients, consisting of 41 (78.8%) males and 11 (21.2%) females (M:F = 3.7:1). The mean of age was 56.1 ± 17.1 years (range: 18-86 years). The mean of latency periods was 24.6 ± 15.0 days (range:1-63 days). Most patients presented with fever, cutaneous eruption, eosinophilia, lymphadenopathy, and facial edema. 36/52 (69.2%) patients showed two or more internal organs involved. Liver and kidney injuries were the most common visceral manifestation. Pulmonary involvement (34.6%), cardiac involvement (25.0%) and gastrointestinal involvement (21.2%) were relatively less known but severe complications. 2/52 (3.8%) patients showed nervous system involved, presenting as leukoencephalopathy or peripheral neuropathy. 2/52 (3.8%) patients presented with secondary hemophagocytic lymphohistiocytosis.1/52 (1.9%) patient developed pure red cell aplasia and 1/52 (1.9%) patient developed painless thyroiditis. HLA*B 58:01 allele was tested in 18/52 (34.6%) patients. 16/18 (88.9%) cases were positive. 48/ 52 (92.3%) patients were treated with systemic corticosteroids. 16/52 (30.8%) patients were cured, 23/52 (44.2%) patients received partial recovery, and 13/52 (25.0%) patients were died. Septic shock, gastrointestinal bleeding and multiple organ failure were the leading causes of death. Advanced age, underlying cardiovascular disease, chronic kidney disease and high dose of allopurinol, infection and internal organ involvement (including kidney, heart, lung and gastrointestinal tract) were risk factors for death. What is New and Conclusion: We explored clinical features, treatment outcomes and prognostic factors of 52 allopurinol-induced DRESS cases in China. Ethnicity, especially Han Chinese, and positive HLA-B*58:01 allele are the clearest risk factors so far. Advanced age, underlying cardiovascular disease, chronic kidney disease and high dose of allopurinol, infection and internal organ involvement (including kidney, heart, lung and gastrointestinal tract) were associated with poorer outcomes. Early

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Severe Cutaneous Adverse Reactions: A Single-Center Retrospective Study of 173 Patients in China

Cited by 5 publications

References 41 publications

Worldwide Prevalence of Antibiotic-Associated Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Worldwide Prevalence of Antibiotic-Associated Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Severe Cutaneous Adverse Drug Reactions at a Tertiary Care Center in Saudi Arabia

Clinical features, treatment outcomes and prognostic factors of allopurinol‐induced DRESS in 52 patients

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