• IMMUNE NETWORK
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• 제16권4호
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• pp.256-260
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• 2016

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-2Ra 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.

• Journal of Korean Dental Science
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• 제17권2호
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• pp.75-83
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• 2024

Stevens-Johnson syndrome (SJS) is a severe adverse cutaneous drug reaction seen rarely in clinical practice. Although relatively rare, the condition can be fatal. Mainly, it is caused by side effects of certain medications. Previous reports have associated Stevens-Johnson syndrome with abnormal root development, but the other long-term dental complications have rarely been reported. In this case, the patient developed SJS at the age of 5, and abnormal root development of the maxillary and mandibular first molars and mandibular incisors was observed, as well as impaction of the mandibular canine and enamel hypomineralization of multiple teeth. Accordingly, appropriate restorative treatment and orthodontic treatment were performed, and the clinical characteristics of this symptoms and its treatment were discussed in more detail. We aim to highlight the need for dentists to be aware of the potential dental complications of SJS and to enable early diagnosis and management of the condition to avoid undesirable sequelae.

• 한국치위생학회지
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• 제8권4호
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• pp.31-41
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• 2008

Steven-Johnson syndrome (SJS) and toxic epidermal necrolysis(TEN) are severe mucocutaneous reaction which are most frequently caused by drugs. Although the incidence of SJS and TEN is known to be relatively low, outcomes may be fatal. A systematic approach is required because morbidity rate is currently increasing and oral lesion is frequent. We investigated the clinical features and outcomes of 6 patients diagnosed as SJS and TEN and referred from the department of dermatology, Chonnam National University Hospital for oral care. Ketoconazol, Ofloxacin, Chlorphenesin, Amoxicillin, Pontal, Harnal, and Ciprofloxacin were suspected as the causative drugs. Average treatment period was 3.2 weeks, and two patients were referred to 'burn-patients' hospital. Most of oral lesion were cured be normal tissue, but scares with discoloration were observed. For intraoral management, antibiotic disinfection and steroid application were performed according to systemic treatment principles. Additionally, ingestion of zinc, antioxidants, and vitamin was recommended. The establishment of oral treatment principles is demanded because it has not been yet. Also, through investigation of drug side effect and careful prescription are required.

• 한국임상약학회지
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• 제23권4호
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• pp.344-364
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• 2013

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are immune-complex-mediated hypersensitivity reactions that predominantly involve skin and mucous membranes. Despite the low incidence, both are considered medical emergencies as the mortality rate has been estimated at 30-50%. Although as many as half of cases are idiopathic, several drugs have been implicated as main cause of SJS/TEN. This review therefore aimed to identify drugs that were potentially associated with SJS/TEN and compare the relative risk of the medications. Method: A comprehensive search was performed using MEDLINE, EMBASE and 5 Korean databases. We defined study drugs as non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, antiepileptics, and allopurinol. Only epidemiologic studies investigating associations between the above drugs and drug-induced SJS/TEN were included. Two reviewers independently selected and evaluated candidate papers and extracted odds ratios or incidence rates. Meta-analysis was performed only for drugs that were reported from 4 or more studies. Results: We found 8 case-control studies, 3 cohort studies and 1 RCT. The ranges of adjusted ORs were 0.6-34.0 for NSAIDs, 1.6-302.0 for antiepileptics, 0.3-10.0 for antibiotics and 1.0-187.0 for allopurinol. The drug with the highest incidence of SJS/TEN was carbamazepine (40 persons/1,000 DDD). Conclusion: Finally, the risk was highest in first 8 weeks after onset of treatment in all drugs.

• Journal of Oral Medicine and Pain
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• 제36권4호
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• pp.207-213
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• 2011

구강 점막에 발생하는 동통성 궤양은 다양한 질환에 의해 발생할 수 있다. 구강내 병소가 발생한 후 피부병소가 발생하는 질환 또는 구강과 피부 동시에 병소가 발생하는 질환의 경우, 구강내만 국한하여 검사를 시행하고 피부 병소를 간과할 때는 진단이 어려울 수 있다. 본 증례에서는 구강 및 전신에 발생한 통증성, 미란성 병소가 나타나는 다형홍반 및 Stevens-Johnson syndrome(SJS) 환자를 경험하여 이를 보고하고 피부병소가 동반되는 구강점막 질환에 대해 고찰해 보고자 한다.

• 대한소아치과학회지
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• 제44권4호
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• pp.455-460
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• 2017

스티븐 존슨 증후군(Stevens-Johnson syndrome, SJS)은 피부와 점막에 광범위한 괴사를 초래하는 매우 심각한 급성 과민반응이다. SJS은 모든 연령대에서 발생할 수 있는 질환으로 원인은 명확하지는 않지만 대부분 약물 알레르기에 의한 것으로 알려져 있으며 그 외에도 세균감염에 의해 유발되기도 한다고 알려져 있다. 전체 표피면적의 10% 이하에서 병변이 발생한 경우를 SJS라 하며 30% 이상에서 발생한 경우를 독성 표피 괴사융해라 정의한다. SJS는 1년에 100만명 인구 당 1 - 2명 미만에서 드물게 발생하나, 성장기 어린아이에게 발생할 경우 치아발육 등에 미치는 영향을 미치게 된다. 6 - 7세경 상하악 제1대구치와 하악중절치의 맹출이 시작되고 이 시기에 치근의 발육이 함께 일어난다. 이 케이스의 환아의 경우 6세경 SJS이 발병하였다. 현재 완치된 상태이나 몇몇 후유증이 남아있는 상태이다. 환아는 이 시기에 발육이 완성되는 치아에 국한되어 발육이상이 관찰되었다. 구강내 특징으로 이러한 전신질환을 진단하고 이로 인한 치아 발육에 대한 영향에 대한 문제점을 인식하고 해결하고자 이 보고서를 쓰는 바이다.

• Journal of Interdisciplinary Genomics
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• 제3권1호
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• pp.7-12
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• 2021

Adverse drug reactions (ADRs) is a hypersensitivity reactions to specific medications, and remain a common and major problem in healthcare. ADRs suchc as drug-induced liver injury and life-threatening severe cutaneous adverse drug reactions including Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug rash with eosinophilia and systemic symptoms can be occurred by uncontrolled expansion of oligoclonal T cells according to genetically predisposing HLA. In this review, I summarized the alleles of HLA genes which have been proposed to have association with ADRs caused by different drugs.

• Clinical and Experimental Pediatrics
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• 제53권3호
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• pp.437-441
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• 2010

독성표피괴사용해(TEN)와 스티븐-존슨 증후군(SJS)은 약물이나 감염에 의해 발생하는 피부점막을 침범하는 드물지만 치명적인 질병이다. 스테로이드는 TEN의 치료에 많이 이용되어왔지만, 아직까지도 논쟁중이다. 스테로이드에 의한 정신과적 영향은 두통, 불면증, 우울증, 심리질환 등이 있다. 스테로이드에 의한 정신질환에서 치료는 스테로이드의 감량 또는 중단이고, 항정신성 약물을 투여한다. 신증후군으로 진단된 11세 남아에서 스테로이드 치료 후 관해상태에서 유지치료를 시행하고 있던 중에 TEN이 발생하였다. 저자들은 이 환아에서 치료목적으로 투여한 고용량 스테로이드 정맥주사로 인해 정신질환이 동반되었고, 이후 스테로이드 감량과 항정신성 약물과 면역글로불린으로 증상이 호전되는 것을 경험하여 이를 보고하는 바이다.

• Journal of Korean Neurosurgical Society
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• 제58권2호
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• pp.163-166
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• 2015

The prophylactic use of phenytoin during and after brain surgery and cranial irradiation is a common measure in brain tumor therapy. Phenytoin has been associated with variety of adverse skin reactions including urticaria, erythroderma, erythema multiforme (EM), Stevens-Johnson syndrome, and toxic epidermal necrolysis. EM associated with phenytoin and cranial radiation therapy (EMPACT) is a rare specific entity among patients with brain tumors receiving radiation therapy while on prophylactic anti-convulsive therapy. Herein we report a 41-year-old female patient with left temporal glial tumor who underwent surgery and then received whole brain radiation therapy and chemotherapy. After 24 days of continous prophylactic phenytoin therapy the patient developed minor skin reactions and 2 days later the patient returned with generalized erythamatous and itchy maculopapuler rash involving neck, chest, face, trunk, extremities. There was significant periorbital and perioral edema. Painful mucosal lesions consisting of oral and platal erosions also occurred and prevented oral intake significantly. Phenytoin was discontinued gradually. Systemic admistration of corticosteroids combined with topical usage of steroids for oral lesions resulted in complete resolution of eruptions in 3 weeks. All cutaneous lesions in patients with phenytoin usage with the radiotherapy must be evoluated with suspicion for EM.

• Translational and Clinical Pharmacology
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• 제25권2호
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• pp.63-66
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• 2017

Allopurinol-induced severe cutaneous adverse reactions (SCARs) such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome are reportedly associated with the $HLA-B^{\star}58:01$ genotype. Three patients who developed SCARs after allopurinol administration were subjected to HLA-B genotyping and lymphocyte activation test (LAT) to evaluate genetic risk and to detect the causative agent, respectively. All three patients given allopurinol to treat gout were diagnosed with DRESS syndrome. Symptom onset commenced 7-24 days after drug exposure; the patients took allopurinol (100-200 mg/d) for 2-30 days. HLA-B genotyping was performed using a polymerase chain reaction (PCR)-sequence-based typing (SBT) method. All patients had a single $HLA-B^{\star}58:01$ allele: $HLA-B^{\star}13:02/^{\star}58:01$ (a 63-year-old male), $HLA-B^{\star}48:01/^{\star}58:01$ (a 71-year-old female), and $HLA-B^{\star}44:03/^{\star}58:01$ (a 22-year-old male). Only the last patient yielded a positive LAT result, confirming that allopurinol was the causative agent. These findings suggest that patients with $HLA-B^{\star}58:01$ may develop SCARs upon allopurinol administration. Therefore, HLA-B genotyping could be helpful in preventing serious problems attributable to allopurinol treatment, although PCR-SBT HLA-B genotyping is time consuming. A simple genotyping test is required in practice. LAT may help to identify a causative agent.