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      Oxcarbazepine-induced Stevens Johnson syndrome: A rare case report

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          Abstract

          Although carbamazepine is the most common cause of Stevens Johnson syndrome (SJS) a new antiepileptic drug, oxcarbazepine which is structurally related to carbamazepine, has also been rarely shown to induce SJS. Here we report a case with SJS, which was induced by oxcarbazepine.

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          Allopurinol is the most common cause of Stevens-Johnson syndrome and toxic epidermal necrolysis in Europe and Israel.

          Sima Halevy, Pierre-Dominique Ghislain, Maja Mockenhaupt … (2008)
          Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare severe cutaneous adverse reactions. We sought to update knowledge on the causes of SJS or TEN with a focus on the rate of allopurinol-associated cases and to identify risk factors for allopurinol-associated SJS or TEN. We conducted a multinational case-control study. In all, 379 patients with severe cutaneous adverse reactions validated as SJS or TEN and 1505 matched hospitalized control subjects were enrolled. Allopurinol was the drug most frequently associated with SJS or TEN, with 66 exposed patients (17.4%) and 28 exposed control subjects (1.9%) (adjusted odds ratio = 18, 95% confidence interval: 11-32). Allopurinol use was greater than in a previous case-control European study. Daily doses equal to or greater than 200 mg were associated with a higher risk (adjusted odds ratio = 36, 95% confidence interval: 17-76) than lower doses (adjusted odds ratio = 3.0, 95% confidence interval: 1.1-8.4). The risk was restricted to short-term use (
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            Correlations between clinical patterns and causes of erythema multiforme majus, Stevens-Johnson syndrome, and toxic epidermal necrolysis: results of an international prospective study.

            , Osvaldo Correia, Jean Claude Roujeau … (2002)
            It was proposed that Stevens-Johnson syndrome and toxic epidermal necrolysis differed from erythema multiforme majus by the pattern and localization of skin lesions. To evaluate the validity of this clinical separation. Case-control study. Active survey from 1989 to 1995 of 1800 hospital departments in Europe. A total of 552 patients and 1720 control subjects. Cases were sorted into 5 groups (erythema multiforme majus, Stevens-Johnson syndrome, Stevens-Johnson syndrome-toxic epidermal necrolysis overlap, toxic epidermal necrolysis, and unclassified erythema multiforme majus or Stevens-Johnson syndrome) by experts blinded as to exposure to drugs and other factors. Etiologic fractions for herpes and drugs obtained from case-control analyses were compared between these groups. Erythema multiforme majus significantly differed from Stevens-Johnson syndrome, overlap, and toxic epidermal necrolysis by occurrence in younger males, frequent recurrences, less fever, milder mucosal lesions, and lack of association with collagen vascular diseases, human immunodeficiency virus infection, or cancer. Recent or recurrent herpes was the principal risk factor for erythema multiforme majus (etiologic fractions of 29% and 17%, respectively) and had a role in Stevens-Johnson syndrome (etiologic fractions of 6% and 10%) but not in overlap cases or toxic epidermal necrolysis. Drugs had higher etiologic fractions for Stevens-Johnson syndrome, overlap, or toxic epidermal necrolysis (64%-66%) than for erythema multiforme majus (18%). Unclassified cases mostly behaved clinically like erythema multiforme. This large prospective study confirmed that erythema multiforme majus differs from Stevens-Johnson syndrome and toxic epidermal necrolysis not only in severity but also in several demographic characteristics and causes.
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              Risk of Stevens-Johnson syndrome and toxic epidermal necrolysis in new users of antiepileptics.

              Pat Tennis, J Schlingmann, Maja Mockenhaupt … (2005)
              Estimates of risk of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) associated with some antiepileptic drugs (AEDs) have used denominators based on the number of prescriptions or daily doses. Because the risk of SJS is highest in new users of drugs, the use of denominators reflective of all users can lead to low estimates of risk associated with drugs. In this study, risk in new users is assessed. Data on all hospitalized patients with SJS and TEN with use of carbamazepine (CBZ), lamotrigine (LTG), phenobarbital (PHB), phenytoin (PHT), or valproic acid (VPA) were obtained from the German Registry for Serious Cutaneous Reactions. For 1998-2001, the numbers of new users were estimated from number of dispensed prescriptions in Germany, the average prescribed doses, and the duration of use in the Mediplus database (IMS Health) Germany, and assumptions that relate new use to growth in national dispensings. To minimize the probability of underestimating risk in new users, conservative estimates of new use that were somewhat lower than predicted from national prescription data were used. More than 90% of SJS and TEN cases occurred in the first 63 days of AED use. Over the 4 years, increases in dispensing were 5% for CBZ, 65% for LTG, 6% for PHB, -16% for PHT, and 26% for VPA. Across a range of assumptions about frequency of incident use, the risk estimates vary between 1 and 10 per 10,000 new users for CBZ, LTG, PHT, and PHY and were consistently lower for VPA. Across a range of assumptions used, the risk of hospitalization for Stevens-Johnson syndrome or toxic epidermal necrolysis in new users is low for carbamazepine, lamotrigine, phenytoin, phenobarbital, and valproic acid. Because conservative incidence use fractions were used, it is likely that some risks were overestimated.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian Dermatol Online J
                Journal ID (iso-abbrev): Indian Dermatol Online J
                Journal ID (publisher-id): IDOJ
                Title: Indian Dermatology Online Journal
                Publisher: Medknow Publications Pvt Ltd (India )
                ISSN (Print): 2229-5178
                ISSN (Electronic): 2249-5673
                Publication date (Print): Jan-Jun 2011
                Volume: 2
                Issue: 1
                Pages: 13-15
                Affiliations
                [1]Department of Neurology, NEIGRIHMS, North Eastern Indira, Gandhi Regional Institute of Medical Sciences, Shillong, India
                Author notes
                Address for correspondence: Dr. Shri Ram Sharma, Department of Neurology, NEIGRIHMS, North Eastern Indira Gandhi Regional Institute of Medical Sciences, Shillong, India. E-mail: srmsims_sharma@ 123456rediffmail.com
                Article
                Publisher ID: IDOJ-2-13
                DOI: 10.4103/2229-5178.79861
                PMC ID: 3481788
                PubMed ID: 23130207
                SO-VID: 9d229030-7a11-404b-8fc1-a2de09974fd1
                Copyright © © Indian Dermatology Online Journal
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Dermatology
                Keywords: solitary small enhancing computerized tomography lesion,oxcarbazepine,stevens-johnson syndrome
                Data availability:
                ScienceOpen disciplines: Dermatology
                Keywords: solitary small enhancing computerized tomography lesion, oxcarbazepine, stevens-johnson syndrome

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