Stevens–Johnson syndrome induced by acetazolamide

Abstract

Acetazolamide is a sulfonamide derivative and carbonic anhydrase inhibitor used to lower intraocular pressure in glaucomatous patients. Stevens-Johnson syndrome (SJS) toxic epidermal necrolysis (TEN) associated with acetazolamide treatment has been diagnosed in Japanese, Japanese-American and Indian patients. Herein, we report the second Korean case of SJS-TEN associated with acetazolamide treatment. The result of human leukocyte antigen (HLA) typing of our patient was positive for HLA-B59. According to recent research, HLA-B59 has been detected in SJS caused by metazolamide, which is analogous to acetazolamide. This suggests a possible relationship between genetic background and SJS-TEN-associated acetazolamide treatment. Theretofore, acetazolamide should be prescribed to Korean patients with the same discreet caution.

Toxic epidermal necrolysis induced by methazolamide in a Chinese–Korean man carrying HLA‐B*59:01

“…Instances of SJS/TEN induced by carbonic anhydrase inhibitors are rare, and in all reported cases, patients had received at least one and often more doses of oral carbonic anhydrase inhibitors to lower intraocular pressure. Previous reports indicate that SJS/TEN usually occurs 11–15 days after the first exposure of the patient to methazolamide . All of the patients reported so far have been Japanese or Korean or of such descent.…”

“…HLA‐B*59 is also found to have a strong correlation with methazolamide‐ and acetazolamide‐induced SJS/TEN. Genotyping shows that about 93.8% (75–100%) of patients with SJS/TEN induced by methazolamide have the HLA‐B*59 allele …”

“…Previous reports indicate that SJS/TEN usually occurs 11-15 days after the first exposure of the patient to methazolamide. [2][3][4][5][6] All of the patients reported so far have been Japanese or Korean or of such descent. No patients of Chinese-Korean ethnicity have been reported.…”

“…Genotyping shows that about 93.8% (75-100%) of patients with SJS/TEN induced by methazolamide have the HLA-B*59 allele. [2][3][4][5] Among the antibiotics, sulfonamides are the most strongly associated with SJS/TEN. 6 Although methazolamide is a sulfonamide derivative, current theory does not support the notion that SJS/TEN induced by sulfonamide derivatives implicates the sulfonamide group.…”

Can Arterial Spin-Labeling with Multiple Postlabeling Delays Predict Cerebrovascular Reserve?

“…6 Moreover, severe or life-threatening adverse events have been reported, including reversible pontine ischemia, pulmonary edema, StevensJohnson syndrome, and anaphylaxis with the risk of morbidity and mortality. [7][8][9][10][11] Several contraindications to acetazolamide also exist, including hypersensitivity to other sulfonamides or severe hepatic and renal disease. 5 Arterial spin-labeling (ASL) perfusion MR imaging provides a noninvasive, repeatable method for quantifying the CBF using magnetically labeled arterial blood as an endogenous tracer without exposure to radiation and also provides higher spatial resolution than SPECT.…”