Stevens Johnson Syndrome Like Skin Lesions in a Patient With Systemic Lupus Erythematosus After Hydroxychloroquine Treatment, a Case

Abstract

Abstract Stevens Johnson Syndrome (SJS) is a clinical syndrome with a high morbidity and mortality, characterized by exfoliation of the skin, generally due to medications, and less frequently due to infections. Most frequently sulphonamides, penicillin, and anti-convulsants were among blamed medications. Systemic lupus erythematosus (SLE) is a systemic auto-immune disorder and skin involvement is frequently seen. Hydroxychloroquine (HCQ) is an important agent which is used in the treatment of SLE and which increases survival. Its side effects include skin reactions. We present here a case of SJS like skin lesions in an 38-years-old female patient with SLE after receiving HCQ. Özet Stevens Johnson Sendromu (SJS), genellikle ilaçlara bağlı olarak ve daha az sıklıkla enfeksiyonlara bağlı olarak cildin dökülmesi ile karakterize, yüksek morbidite ve mortaliteye sahip klinik bir sendromdur. En sık suçlanan ilaçlar sülfonamidler, penisilin ve anti-konvülzanlardır. Sistemik lupus eritematozus (SLE), sistemik bir otoimmün bozukluktur ve cilt tutulumu sıklıkla görülür. Hidroksiklorokin (HCQ), SLE tedavisinde kullanılan ve sağkalımı artıran önemli bir ajandır. Yan etkileri cilt reaksiyonlarını içerir. Burada, HCQ aldıktan sonra SLE'li 38 yaşında bir kadın hastada SJS benzeri deri lezyonları olgusunu sunuyoruz.

Keywords

• Stevens Johnson Sydrome
• hydroxychloroquine
• lupus

References

1. 1. Bastuji-Garin S, Rzany B, Stern RS et al. Clinical classi cation of cases of toxic epidermal necrolysis, Stevens–Johnson syndrome, and erythema multiforme. Arch Dermatol 1993; 129:92–6.
2. 2. Mockenhaupt M. The current understanding of Stevens–Johnson syndrome and toxic epidermal necrolysis. Expert Rev Clin Immunol 2011; 7:803–15.
3. 3. Tay YK, Huff JC,Weston WL. Mycoplasma pneumoniae infection is associated with stevens-johnson sendrome , not erythema multiforme (von hebra). J am Acad dermatol 1996;35:757-60.
4. 4. Andrea Fava, Michelle Petri. Systemic Lupus Erythematosus: Diagnosis and Clinical Management. J Autoimmun. 2019;96:1–13.
5. 5. John B. Imboden, David B. Hellmann, John H.Stone. Current diagnozis and treatment rheumatology 3. Edition. 2013 200-201.
6. 6. Chan HL, Stern RS, Arndt KA, et al. The incidence of erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis. A population-based study with particular reference to reactions caused by drugs among outpatients. Arch Dermatol 1990;126:43-47.
7. 7. Gilliam JN, Sontheimer RD. Distinctive cutaneous subsets in the spectrum of lupus erythematosus. J Am Acad Dermatol. 1981;4:471-5.
8. 8. Akhavan PS, Su J, Lou W, et al. The early protective effect of Hydroxychloroquine on the risk of cumulative damage in patients with systemic lupus erythematosus. J Rheumatol. 2013 Jun;40(6):831-41.

9. 9. M.ziemer , S.H.Kardaun, Y.liss, M.mockenhaupt. Stevens-Johnson syndrome and toxic epidermal necrolysis in patients with lupus erythematosus: a descriptive study of 17 cases from a national registry and review of the literature. British journal of dermatology British Association of Dermatologists 2012 166, pp575–600
10. 10. Lee HY, Tey HL, Pang SM, Thirumoorthy T. Systemic lupus erythematosus presenting as Stevens-Johnson syndrome and toxic epidermal necrolysis: a report of three cases. Lupus. 2011 May;20(6):647-52.
11. 11. Lateef A, Tan KB, Lau TC. Acute generalized exanthematous pustulosis and toxic epidermal necrolysis induced by hydroxychloroquine. Clinical Rheumatology. 2009 Dec;28(12):1449-52.
12. 12. Simsek I, Cinar M, Erdem H, et al. Efficacy of plasmapheresis in the treatment of refractory toxic epidermal necrolysis like acute cutaneous lupus erythematosus. Lupus. 2008;17:605Y606.
13. 13. Leckie MJ, Rees RG. Stevens-Johnson syndrome in association with hydroxychloroquine treatment for rheumatoid arthritis. Rheumatology (Oxford) 2002 Apr;41(4):473-4.
14. 14. Samimi SS, Siegfried E. Stevens-Johnson syndrome developing in a girl with systemic lupus erythematosus on high-dose corticosteroid therapy. Pediatr Dermatol. 2002 Jan-Feb;19(1):52-5.
15. 15. Lee HY, Tey HL, Pang SM, et al. Systemic lupus erythematosus presenting as Stevens-Johnson syndrome and toxic epidermal necrolysis: a report of three cases. Lupus. 2011;20:647Y652.
16. 16. Mandelcorn R, Shear NH. Lupus-associated toxic epidermal necrolysis: a novel manifestation of lupus? J Am Acad Dermatol. 2003;48:525Y529.
17. 17. Ryan E, Marshman G, Astill D. Toxic epidermal necrolysis-like subacute cutaneous lupus erythematosus. Australas J Dermatol. 2012;53:303Y306.
18. 18. Wei CY, Chung WH, Huang HW, Chen YT, Hung SI. Direct interaction between HLA-B and carbamazepine activates T cells in patients with Stevens-Johnson syndrome. J Allergy Clin Immunol 2012; 129(6): 1562-9 e5.
19. 19. Wu Y, Sanderson JP, Farrell J, et al. Activation of T cells by carbamazepine and carbamazepine metabolites. J Allergy Clin Immunol 2006; 118(1): 233-41.
20. 20. Rutter A, Luger TA. High-dose intravenous immunoglobulins: an approach to treat severe immune-mediated and autoimmune disease. J Am Acad Dermatol 2001;44:1010-1024.
21. 21. Viard I, Wehrli P. Bullani R, et al. Inhibition of toxic epidermal necrolysis by blockade of CD95 with human intravenous immunoglobulin. Science 1998;282:490-493.
22. 22. Metry DW, Jung P, Levy ML. Use of intravenous immunoglobulin in children with Stevens-Johnson syndrome and toxic epidermal necrolysis: seven cases and review of the literatüre. Pediatrics 2003;112(6 Pt 1):1430-1436.
23. 23. Kazatchkine MD, Kaveri SV. Immunomodulation of autoimmune and inflammatory diseases with intravenous immune globulin. N Engl J Med 2001;345:747-755.
24. 24. Tanaka M, Suda T, Haze K, et al. Fas ligand in human serum. Nat Med 1996;2:317-322.