Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis Associated with Acetaminophen Use during Viral Infections

Abstract

An association between drug treatment for viral infections and severe cutaneous adverse reactions has been noted. We investigated six patients diagnosed with Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) after being prescribed acetaminophen for suspected viral illnesses. Multiplex analysis was performed to measure cytokine levels in sera before and after treatment. IL-2Rα levels significantly decreased during the convalescence phase. Although acetaminophen is relatively safe, the drug can trigger SJS/TEN in patients with suspected viral infections. T-cells and monocytes may be key components of the link between viral infection and acetaminophen-induced SJS/TEN.

Clinical features of Stevens–Johnson syndrome and toxic epidermal necrolysis

“…And in the present study, the time period between the intake of the causative drug and the start of skin eruption ranged from 0.5 to 13 days (median, 2.0 days), which is shorter than typically reported (1 day–1 month after drug exposure.). Similarly to the present study, SJS/TEN has been reported to develop less than or equal to week after treatment with acetaminophen . And Kaniwa et al .…”

“…It is difficult to establish which drug is specifically responsible for causing SJS/TEN. SJS/TEN has been reported to be associated with acetaminophen ingestion under viral infection . Although acetaminophen is relatively safe, it is suspected that SJS/TEN is caused by an interaction between acetaminophen and viral infection.…”

“…SJS/TEN has been reported to be associated with acetaminophen ingestion under viral infection. 12,13 Although acetaminophen is relatively safe, it is suspected that SJS/TEN is caused by an interaction between acetaminophen and viral infection. A possibly increased susceptibility to acetaminophen was noted in a survey of pediatric SJS/TEN patients.…”

“…Similarly to the present study, SJS/TEN has been reported to develop less than or equal to week after treatment with acetaminophen. 12 And Kaniwa et al noted that in Japanese patients with SJS/TEN accompanied by severe ocular surface involvement, acetaminophen was suspected to be a causative drug, particularly when it was taken for the treatment of the common cold. 15 A high fever and mucous membrane involvement were reported in all of the present patients.…”

Is acetaminophen associated with a risk of Stevens–Johnson syndrome and toxic epidermal necrolysis? Analysis of the French Pharmacovigilance Database

“…Twenty case reports of SJS/TEN related to acetaminophen are available in the international literature , two of them with a positive rechallenge. We were able to apply ALDEN retrospectively using available data in 12 cases.…”