Stevens–Johnson syndrome/toxic epidermal necrolysis associated with zonisamide

Vivar, Karina L.; Mancl, Kimberly; Seminario‐Vidal, Lucia

doi:10.1002/ccr3.1288

Cited by 6 publications

(5 citation statements)

References 12 publications

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“…No cases in this review report cross-reactivity of related agents. However, cases of drug-induced SJS/TEN due to drug cross-reactivity have been reported in the literature [ 105 – 107 ]. The similarities of photodistributed SJS/TEN, all shown to be photo-drug-induced SJS/TEN, are likely because drug-induced SJS/TEN occurs due to a delayed type IV hypersensitivity reaction, similar to photoallergic reactions [ 1 , 54 ].…”

Section: Discussionmentioning

confidence: 99%

“… UVR Ultraviolet radiation, SJS Steven’s–Johnson syndrome, TEN Toxic epidermal necrolysis a Photo component unknown, but ultimately assumed to result in a drug-induced type IV hypersensitive reaction that is seen in SJS/TEN b No specific study reports the incidence of drug-induced SJS/TEN cross-reactivity, although cases have been reported [ 105 – 107 ] c Not mentioned in the literature as findings of phototoxic/photoallergic reactions d Findings rarely reported [ 109 ] …”

Section: Discussionmentioning

confidence: 99%

“…b No specific study reports the incidence of drug-induced SJS/TEN cross-reactivity, although cases have been reported [ 105 – 107 ]…”

Section: Discussionmentioning

confidence: 99%

“…Obtaining a positive Nikolsky’s sign depends on correctly performing and interpreting the findings. One case showed that although 75% of a patient’s BSA presented with a rash consistent with TEN, the Nikolsky’s sign was only positive in 9% of BSA upon presentation, which progressed to 20% when re-evaluated 24 h later [ 107 ]. Thus, if a Nikolsky’s sign is only performed on part of the rash, a false negative may result.…”

Section: Discussionmentioning

confidence: 99%

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Photodistributed Stevens–Johnson syndrome and toxic epidermal necrolysis: a systematic review and proposal for a new diagnostic classification

2023

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Background Ultraviolet radiation (UVR) exposure is commonly reported as a risk factor for Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). However, minimal evaluation of photo-induced SJS/TEN has been conducted. Thus, this review identifies all cases of SJS/TEN that are linked to an acute exposure of UVR and outlines the unifying characteristics of these cases. Furthermore, the theoretical pathogenesis, differential diagnoses, and proposed diagnostic criteria are defined. Methods PubMed, Google Scholar, and other databases and websites were searched from inception to September 2021 to identify studies that met inclusion criteria. The following keywords were utilized: “Stevens-Johnson syndrome” and “toxic epidermal necrolysis” with “ultraviolet,” “photodistributed,” “photo-induced,” “photosensitivity,” and “photo.” One reviewer assessed study characteristics, with confirmation by a second. The risk of bias was assessed independently by another. Results Thirteen patient cases were identified, all reporting ultraviolet radiation prior to rash onset and an underlying causal drug. Case classifications included 7/13 SJS and 6/13 TEN. All cases described the rash as photodistributed with UVR exposure prior to rash onset (delay of 1–3 days) and a causal drug. 10 cases provided evidence that the photodistributed rash lacked linear demarcation (as in a sunburn) with satellite target-like lesions. No cases described a flu-like prodrome. Discussion Mucositis, palmar and plantar rash, a positive Nikolsky sign, and a prolonged disease course can help distinguish from photosensitive reactions, while a negative direct immunofluorescence test is important to distinguish from other photo-induced disorders. Conclusion Physicians should be aware that UVR may precipitate SJS/TEN in patients taking susceptible drugs. After a 24-h delay from UVR exposure, a non-distinct, photodistributed rash appears with no flu-like prodrome and progresses for at least 48 h to include vesiculobullous eruptions and mucous membrane involvement. Photodistributed SJS/TEN appears to be photo-drug-induced with a unique onset and rash presentation that should be recognized as a distinct diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…b No specific study reports the incidence of drug-induced SJS/TEN cross-reactivity, although cases have been reported [ 105 – 107 ]…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Photodistributed Stevens–Johnson syndrome and toxic epidermal necrolysis: a systematic review and proposal for a new diagnostic classification

2023

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“…SJS/TEN is an immune-mediated hypersensitivity and at least 200 drugs have been reported to be related to disease onset. The most common ones are nonsteroidal anti-inflammatory drugs [NSAIDs ( Kowalski et al, 2013 ; Chong and Chao, 2017 )], sulfa-derived medications [e.g., zonisamide ( Vivar et al, 2018 ), sulphapyridine ( Xiong et al, 2018 ), and sulfamethoxazole ( Kongpan et al, 2015 ; Sukasem et al, 2020a ; Wang et al, 2020a )], lactam antibiotics, anticonvulsants (e.g., carbamazepine, phenobarbital, and phenytoin), antiretroviral medicine, contrast agents, antigout drug allopurinol, etc. ( Yang et al, 2019 ; Zhao et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Current Pharmacogenetic Perspective on Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Cheng

2021

Front. Pharmacol.

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Adverse drug reactions are a public health issue that draws widespread attention, especially for Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) which have high mortality and lack of efficacious treatment. Though T-cell-mediated HLA-interacted immune response has been extensively studied, our understanding of the mechanism is far from satisfactory. This review summarizes infection (virus, bacterial, and mycoplasma infection), an environmental risk factor, as a trigger for SJS/TEN. The mutations or polymorphisms of drug metabolic enzymes, transporters, receptors, the immune system genes, and T-cell-mediated apoptosis signaling pathways that contribute to SJS/TEN are discussed and summarized. Epigenetics, metabolites, and mobilization of regulatory T cells and tolerogenic myeloid precursors are emerged directions to study SJS/TEN. Ex vivo lymphocyte transformation test has been exploited to aid in identifying the causative drugs. Critical questions on the pathogenesis of SJS/TEN underlying gene polymorphisms and T cell cytotoxicity remain: why some of the patients carrying the risky genes tolerate the drug and do not develop SJS/TEN? What makes the skin and mucous membrane so special to be targeted? Do they relate to skin/mucous expression of transporters? What is the common machinery underlying different HLA-B alleles associated with SJS/TEN and common metabolites?

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Management of Immune-Related Cutaneous Adverse Reactions to PD-1 and PD-L1 Inhibitors for the Inpatient Dermatologist

2020

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Stevens–Johnson syndrome/toxic epidermal necrolysis associated with zonisamide

Cited by 6 publications

References 12 publications

Photodistributed Stevens–Johnson syndrome and toxic epidermal necrolysis: a systematic review and proposal for a new diagnostic classification

Photodistributed Stevens–Johnson syndrome and toxic epidermal necrolysis: a systematic review and proposal for a new diagnostic classification

Current Pharmacogenetic Perspective on Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Management of Immune-Related Cutaneous Adverse Reactions to PD-1 and PD-L1 Inhibitors for the Inpatient Dermatologist

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