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Current Drug Safety

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ISSN (Print): 1574-8863
ISSN (Online): 2212-3911

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Case Report

Penicillamine-induced Stevens Johnson Syndrome-toxic Epidermal Necrolysis (SJS-TEN) Overlap in an HIV-infected Patient with Wilson’s Disease and Hepatitis B

Author(s): Namrata Chhabra*, Papireddy Shivareddy Meghana Reddy, Ayush Bhatnagar and Satyaki Ganguly

Volume 19, Issue 2, 2024

Published on: 19 June, 2023

Page: [295 - 298] Pages: 4

DOI: 10.2174/1574886318666230525102008

Price: $65

Abstract

Introduction: Stevens-Johnson syndrome (SJS) and Toxic epidermal necrolysis (TEN) are severe adverse drug reactions characterized by widespread blistering and mucositis. Wilson’s disease is a rare, autosomal recessive disorder that results in excessive copper accumulation in the body, where penicillamine is an effective treatment option for copper chelation. Penicillamineinduced SJS-TEN is a rare but potentially fatal adverse effect. There is increased susceptibility to SJS/TEN in HIV infection due to immunosuppression and chronic liver disease due to impaired hepatic function.

Objective: To diagnose and manage the occurrence of the rare severe adverse cutaneous drug reactions in the backdrop of immunosuppression and chronic liver disease.

Case Report: We are reporting penicillamine-induced SJS-TEN overlap in a 30-year-old male with Wilson’s disease, HIV and Hepatitis B who was treated with intravenous immunoglobulins. The patient later developed neurotrophic ulcer in the right cornea as a delayed sequela.

Conclusion: Our case report emphasizes that there is an increased predisposition to SJS/TEN in immunocompromised and chronic liver disease patients. Physicians should be well aware of the potential danger of SJS/TEN in this subset of patients, even while prescribing a relatively safer drug.

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Graphical Abstract

[1]
Walsh S, Lee HR, Creamer D. Severe cutaneous adverse reactions to drugs. In: Chalmers R, Barker J, Griffiths C, Bleiker T, Creamer D, Eds Rook’s textbook of Dermatology 9th ed Oxford: Wiley Blackwell . 2016; pp. 119.13-22.
[2]
Peng AJ, Chen L, Li Y, Fang JJ, Zhou D, Feng P. Penicillamine for Wilson’s disease. Cochrane Database Syst Rev 2017; 2017: CD009739.
[3]
Peter J, Choshi P, Lehloenya RJ. Drug hypersensitivity in HIV infection. Curr Opin Allergy Clin Immunol 2019; 19(4): 272-82.
[http://dx.doi.org/10.1097/ACI.0000000000000545] [PMID: 31145192]
[4]
Hoosen K, Mosam A, Dlova NC, Grayson W. An update on adverse cutaneous drug reactions in HIV/AIDS. Dermatopathology 2019; 6(2): 111-25.
[http://dx.doi.org/10.1159/000496389] [PMID: 31700852]
[5]
Ferner R, Aronson J. Susceptibility to adverse drug reactions. Br J Clin Pharmacol 2019; 85(10): 2205-12.
[http://dx.doi.org/10.1111/bcp.14015] [PMID: 31169324]
[6]
Khandpur S, Jain N, Singla S, Chatterjee P, Behari M. D-penicillamine induced degenerative dermopathy. Indian J Dermatol 2015; 60(4): 406-9.
[http://dx.doi.org/10.4103/0019-5154.160498] [PMID: 26288416]
[7]
Lee YI, Lee MY, Park YT, et al. Penicillamine-induced toxic epidermal necrolysis in a patient with Wilson disease. Allergy Asthma Respir Dis 2014; 2(4): 302-5.
[http://dx.doi.org/10.4168/aard.2014.2.4.302]
[8]
Zimmermann S, Sekula P, Venhoff M, et al. Systemic immunomodulating therapies for stevens-johnson syndrome and toxic epidermal necrolysis. JAMA Dermatol 2017; 153(6): 514-22.
[http://dx.doi.org/10.1001/jamadermatol.2016.5668] [PMID: 28329382]
[9]
Rawal RC, Mangla K, Rastogi S, Goyal P, Solanki RB. Efficacy of low dose intravenous immunoglobulins in children with toxic epidermal necrolysis: An open uncontrolled study. Indian J Dermatol Venereol Leprol 2005; 71(6): 398-400.
[http://dx.doi.org/10.4103/0378-6323.18943] [PMID: 16394480]
[10]
Sobhanakumari K, Sadanandan SM, Ravindran S, et al. Low dose intravenous immunoglobulins and steroids in toxic epidermal necrolysis: A prospective comparative open-labelled study of 36 cases. Indian J Dermatol Venereol Leprol 2013; 79(4): 506-11.
[http://dx.doi.org/10.4103/0378-6323.113080] [PMID: 23760320]
[11]
Perricone C, Triggianese P, Bursi R, et al. Intravenous immunoglobulins at the crossroad of autoimmunity and viral infections. Microorganisms 2021; 9(1): 121.
[http://dx.doi.org/10.3390/microorganisms9010121] [PMID: 33430200]
[12]
Shay E, Kheirkhah A, Liang L, Sheha H, Gregory DG, Tseng SCG. Amniotic membrane transplantation as a new therapy for the acute ocular manifestations of Stevens-Johnson syndrome and toxic epidermal necrolysis. Surv Ophthalmol 2009; 54(6): 686-96.
[http://dx.doi.org/10.1016/j.survophthal.2009.03.004] [PMID: 19699503]

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