Síndrome de Stevens-Johnson e Necrólise Epidérmica Tóxica em um hospital do Distrito Federal

Abstract

This study aimed to analyze demographic and clinical aspects of patients diagnosed with Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), as well as identifying the actions of health professionals for the management of Adverse Drug Reactions (ADR) in a public hospital in Distrito Federal, Brazil. A descriptive and retrospective research was held, with quantitative approach. Data collected from all the records of 22 patients admitted with diagnosed with SJS and TEN, from January 2005 to September 2012. Data were analyzed using descriptive statistics. Of these cases, 9 were diagnosed with NET and 7, with SJS; there were more females (14); aged from 21 to 40 years (10); 21 were cured; the drugs more used were the antiepileptic ones (10). Fragility in clinical registers and in the actions to monitor the cases of ADR in this health service was observed.

Síndrome De Stevens-Johnson E Necrólise Epidérmica Tóxica: Relato De Caso

“…A paciente apresentou quadro de edema agudo de pulmão enquanto internada na UTI, que segundo a literatura científica está entre as complicações mais frequentes da SSJ/NET e entre as principais causas de mortalidade, que são septicemia por Staphylococcus aureus e Pseudomonas aeruginosa, edema agudo de pulmão, tromboembolismo pulmonar e sangramento gastrintestinal (BULISANI, et al, 2006;EMERICK, et al, 2014;RAMOS E SILVA et al, 2010).…”

“…Assim como citado que as sequelas mais comuns são a hiper ou hipopigmentação da pele, as distrofias das unhas e as complicações oculares, isto foi observado na paciente cujo caso aqui se relata, que ao receber alta, apresentava-se com pontos de alteração da pigmentação na pele em locais onde havia lesões, porém não apresentava cicatrizes (RAMOS E SILVA et al, 2010;EMERICK, 2014). As lesões dos lábios e da mucosa bucal geralmente se resolvem sem sequelas, porém as lesões oculares são as de maior morbidade, entretanto a paciente evoluiu com melhora de ambas, tanto do acometimento mucoso oral quanto ocular.…”

“…Numerosos casos necessitam de internação em unidades de terapia intensiva com fluidos intravenosos, suporte nutricional, roupas leves, camas especiais, analgesia e cateterismo vesical. Os antibióticos são muito importantes nas infecções bacterianas secundárias que, eventualmente, podem levar a morte (EMERICK, et al, 2014;FERNÁNDEZ et al, 2011).…”

A Case Report: Toxic Epidermal Necrolysis in Children

“…Furthermore, multiple comorbidities, use of treatment medication, and advanced age seem to be risk factors for the disease. [1][2][3][4][5] The most common medications linked to TEN onset are sulphas, phenobarbital, carbamazepine, dipyrone, piroxicam, phenylbutazone, aminopenicillins, and allopurinol. [1][2][3] The main clinical difference between TEN and Stevens-Johnson syndrome (SJS) is the percentage body surface covered by cutaneous lesion and a positive or negative Nikolsky sign (NS).…”

“…Patients with TEN show a positive NS over large areas of skin.4 By definition, lesions affect less than 10% of body surface area in SJS, 10 to 30% in SJS/TEN overlap, and over 30% in TEN. [4][5] Prognosis and risk of death in patients with TEN is evaluated using the SCORTEN (SCORe of Toxic Epidermal Necrosis), a severity score developed by Bastuji-Garin et al The tool considers seven parameters: Age > 40 years, malignancy, heart rate (HR) > 120 bpm, epidermal detachment > 10%, serum urea > 28 mg/dL, serum glucose > 252 mg/dL, and serum bicarbonate > 20 mg/dL. 6…”