Toxic epidermal necrosis

Idiosyncratic dmg reactions (IDRs) are most commonly characterized by a reaction involving fever or rash, with or without internal organ involvement. The spectrum of responses ranges from a minor rash, to potentially fatal toxic epidermal necrosis and Stevens-Johnson syndrome. Immunoglobulin E (IgE)-mediated anaphylactic shock, occasional joint pain, hepatotoxicity or nephrotoxicity are also well documented [24]. The frequency of such reactions are unknown but estimated to be between 1 1000 and 1 10000 exposures and may be enhanced on re-challenging susceptible individuals with the same dmg. 

Serious events - meloxicam has been implicated in the following serious adverse events GI bleeding, MI, stroke, GI ulceration and perforation, anaphylactoid reactions, HTN, CHF, bronchospasm, nephrotoxicity, renal papillary necrosis, hepatotoxicity, exfoliative dermatitis, blood dyscrasias, anemia, toxic epidermal necrosis, Stevens-Johnson syndrome, thromboembolism [1,5]. 

There were no cases of osteonecrosis of the jaw, toxic epidermal necrosis, Ste-vens-Johnson syndrome, or drug rash with eosinophilia and systemic symptoms (DRESS). 

Skin A serious cutaneous adverse reaction was recently linked to tranexamic acid in a patient with liver cirrhosis and acute rectal bleeding. A 67-year-old male was prescribed oral tranexamic acid, which partially resolved his symptoms. However, 10 days after treatment began a purplish rash appeared on the patient s trunk, which became confluent with blisters and epidermal necrosis over the following days. Tranexamic acid was suspended and a skin biopsy was found to be consistent with toxic epidermal necrosis (TEN). Resolution of the skin lesions was favourable with fluid replacement, oral prednisone and N-acetylcysteine, but after 2 weeks the patient died secondary to acute renal failure, respiratory infection and multiorgan failure. This is the first report of TEN that occurred in a patient being treated with oral tranexamic acid [66 ]. 

Toxic epidermal necrolysis Epidermal necrosis with skin detachment Present As above Supportive0... 

Exposure to high concentrations may cause tracheobronchitis and pulmonary edema. The irritation threshold in humans is 0.2 5-0.5 ppm, and concentrations above Ippm are extremely irritating to all mucous membranes within 5 minutes. Fatalities have been reported at levels as low as 10ppm, and 150 ppm was lethal after 10 minutes. The violent irritant effect usually prevents chronic toxicity in humans. Skin contact causes irritation, burns, and epidermal necrosis." Eye splashes cause corneal damage, palpebral edema, blepharoconjunctivitis, and fibrinous or purulent discharge. ... 

Potentially fatal reactions to sulfonamides Fatalities have occurred, although rarely, as a result of severe reactions to sulfonamides (eg, zonisamide), including Stevens-Johnson syndrome, toxic epidermal necrolysis, fulminant hepatic necrosis, agranulocytosis, aplastic anemia, and other blood dyscrasias. 

Skin - Severe, occasionally fatal dermatologic reactions, including toxic epidermal necrolysis, Stevens-Johnson syndrome, exfoliative dermatitis, skin necrosis, and erythema multiforme, have been reported within days of methotrexate administration. 

A variety of idiosyncratic reactions may be seen shortly after therapy has begun. Skin rashes, usually morbilliform in character, are most common. Exfoliative dermatitis or toxic epidermal necrolysis (Lyellis syndrome) has been observed but is infrequent. Other rashes occasionally have been reported, as have a variety of blood dyscrasias and hepatic necrosis. 

Adverse effects that are not unequivocally related to inhibition of prostaglandin synthesis include hepatic effects (hepatitis, hepatic necrosis, cholestatic jaundice, increased serum aminotransferases), dermal effects (photosensitivities, Stevens-Johnson syndrome, toxic epidermal necrolysis, onycholysis), central nervous system (CNS) effects (headaches, dizziness, tinnitus, deafness, drowsiness, confusion, nervousness, increased sweating, aseptic meningitis), ocular effects (toxic amblyopia, retinal disturbances), and certain renal effects (acute interstitial nephritis, acute papillary necrosis). 

Nevirapine (Viramune) is approved for the treatment of HIV infection in adults and children as part of a combination therapy. During the first 12 weeks of treatment, patients must be closely monitored for the development of potentially fatal hepatic toxicity (i.e., hepatitis, hepatic necrosis, and hepatic failure) and skin reactions (i.e., Stevens-Johnson syndrome, toxic epidermal necrolysis, and hypersensitivity reactions). Although these toxici-ties are rare, common side effects include mild to moderate rash, fever, nausea, fatigue, headache, and elevated liver enzymes. 

Warnings Deaths due to following severe reactions have occurred after treatment with SMX Stevens-Johnson syndrome Toxic epidermal necrolysis Fulminant hepatic necrosis Agranulocytosis Aplastic anemia Other blood dyscrasias Hypersensitivity of the respiratory tract Should not be used for the treatment of streptococcal pharyngitis o c D [Pg.43]

Toxic epidermal necrolysis has been associated with clobazam (SEDA-21, 48). Bullae with sweat gland necrosis rarely complicate coma, but have recently been reported in association with clobazam, used as adjunctive therapy for resistant epilepsy in a 4-year-old girl (9). 

Sweat gland necrosis (1986) Rocamora A+, J Dermatol 13,49 Toxic epidermal necrolysis (1990) Llibre LM +, Med Clin (Bare) (Spanish) 94, 799 Ulcerations... 

Adrenaline hypertension Anticoagulants, oral skin necrosis Antituberculosis drugs hepatotoxicity Pseudoephedrine toxic epidermal necrolysis SSRIs suicidal behavior Statins acute pancreatitis Ximelagatran liver damage... 

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