Toxic epidermal necrolysis with systemic lupus erythematosus: case report and review of the literature

Abstract

Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are potentially fatal mucocutaneous diseases characterized by extensive necrosis and exfoliation of the epidermis. TEN and SJS are most often caused by various kinds of drugs. Other risk factors for SJS/TEN include pneumonia infection, HIV infection, genetic factors, underlying immune diseases, and tumors. SJS and TEN were first identified in 1922, but at present, a widely recognized view is that SJS and TEN represent phases in the continuous progress of the same disease. SJS/TEN has a very high mortality, but is rare, and cases of SJS/TEN combined with systemic lupus erythematosus (SLE) are even less common. Occasionally, acute cutaneous manifestations of SLE and SJS/TEN can be phenotypically similar, both causing extensive epidermal necrosis. In this paper, we present a recent case of a 32-year-old female SLE patient with a druginduced (the health product, astaxanthin) TEN/SJS. To provide context to this case, we have reviewed relevant case studies published in English, accessed via PubMed databases. The search covers all published case studies from 1988 to 2019. We collected a total of 30 cases in the literature, and analyzed their characteristics from the aspects of gender, suspicious medication history, and treatment in order to expand clinicians' approach to diagnosis and treatment.

An Indonesian female with Stevens-Johnson syndrome mimicking cutaneous lupus: A case report

“…The diagnosis of lupus-induced SJS/TEN and classical SJS/TEN is difficult. Lupus-induced SJS/TEN was a subacute presentation of weeks without systemic involvement and no history of drug ingestion [ 11 ]. Classical TEN was acute evolution within 3–4 days or sometimes hours, with a close drug-related causality and negative immunofluorescence [ 12 ].…”

Stevens-Johnson Syndrome From Combined Allopurinol and Angiotensin-Converting Enzyme Inhibitors: A Narrative Review

“…Other studies found the culprit drugs that were at high risk for triggering SJS were phenytoin, lamotrigine, and allopurinol [21,22]. An increased risk for developing SJS is associated with factors such as age, autoimmune disease, previous drug allergies, epilepsy, or a history of cerebrovascular accident [23][24][25].…”

Necrólisis epidérmica toxica en un paciente de 13 años

“…El diagnóstico es clínico y a través de biopsia de la piel con tinción de hematoxilina-eosina. (Hasegawa et al., 2022; Wung et al, 2022)Se utiliza la escala de SCORTEN para determinar la probabilidad de muerte en NET (Fan et al, 2022;Cetin et al;2013)…”