Reactions 1459 - 6 Jul 2013 S Amoxicillin Stevens-Johnson syndrome progressing to toxic epidermal necrolysis, treated with etanercept: case report A 32-year-old man developed Stevens-Johnson syndrome (SJS) progressing to toxic epidermal necrolysis (TEN) while receiving amoxicillin; he was successfully treated with etanercept. The man was HIV seropositive and had stopped taking his antiretroviral medication. He presented with generalised skin eruptions and a 1-day history of fever. Four days earlier, he had been prescribed prophylactic amoxicillin [dosage and route not stated] and mefenamic acid following a dental procedure. On examination, he had painful erythematous macules and blisters on his trunk, limbs and face. He also had conjunctivitis and ulcers on his lips and oral mucosa. There was epidermal detachment involving 9% of his total body surface area (TBSA). Laboratory investigations found elevated creatinine, ALT and CRP levels, and skin biopsy revealed a detached and completely necrotic epidermis. He was diagnosed with SJS with a SCORTEN score of 1. Lymphocyte transformation tests and patch tests were positive for amoxicillin and negative for mefenamic acid. The man received methylprednisolone; however, it was withdrawn after a single dose to avoid a potential HIV outbreak. On hospital day 3, his epidermal detachment had progressed to 40% of his TBSA, and his diagnosis was changed to TEN. His symptoms continued to progress, and he was treated with two injections of etanercept 50mg and 25mg on days 3 and 5, respectively. He also received antiretrovirals for his HIV. Subsequently, he did not develop any new lesions or fever, and re-epithelialisation occurred thereafter. Fourteen days after receiving etanercept, his mucocutaneous lesions had resolved completely, and he was discharged in a stable condition. Author comment: "Results of lymphocyte transformation test were positive for amoxicillin and negative for mefenamic acid. The patch test was also positive for amoxicillin and negative for mefenamic acid. Therefore, the probable causative agent was amoxicillin." Lee Y-Y, et al. Use of etanercept to treat toxic epidermal necrolysis in a human immunodeficiency virus-positive patient. Dermatologica Sinica 31: 78-81, No. 2, Jun 2013. Available from: URL: http://dx.doi.org/10.1016/j.dsi.2012.06.005 - Taiwan 803089285 1 Reactions 6 Jul 2013 No. 1459 0114-9954/10/1459-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

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Reactions 1459 - 6 Jul 2013

SAmoxicillin

Stevens-Johnson syndrome progressing to toxicepidermal necrolysis, treated with etanercept: casereport

A 32-year-old man developed Stevens-Johnson syndrome(SJS) progressing to toxic epidermal necrolysis (TEN) whilereceiving amoxicillin; he was successfully treated withetanercept.

The man was HIV seropositive and had stopped taking hisantiretroviral medication. He presented with generalised skineruptions and a 1-day history of fever. Four days earlier, he hadbeen prescribed prophylactic amoxicillin [dosage and routenot stated] and mefenamic acid following a dental procedure.On examination, he had painful erythematous macules andblisters on his trunk, limbs and face. He also had conjunctivitisand ulcers on his lips and oral mucosa. There was epidermaldetachment involving 9% of his total body surface area (TBSA).Laboratory investigations found elevated creatinine, ALT andCRP levels, and skin biopsy revealed a detached andcompletely necrotic epidermis. He was diagnosed with SJSwith a SCORTEN score of 1. Lymphocyte transformation testsand patch tests were positive for amoxicillin and negative formefenamic acid.

The man received methylprednisolone; however, it waswithdrawn after a single dose to avoid a potential HIVoutbreak. On hospital day 3, his epidermal detachment hadprogressed to 40% of his TBSA, and his diagnosis was changedto TEN. His symptoms continued to progress, and he wastreated with two injections of etanercept 50mg and 25mg ondays 3 and 5, respectively. He also received antiretrovirals forhis HIV. Subsequently, he did not develop any new lesions orfever, and re-epithelialisation occurred thereafter. Fourteendays after receiving etanercept, his mucocutaneous lesionshad resolved completely, and he was discharged in a stablecondition.

Author comment: "Results of lymphocyte transformationtest were positive for amoxicillin and negative for mefenamicacid. The patch test was also positive for amoxicillin andnegative for mefenamic acid. Therefore, the probablecausative agent was amoxicillin."Lee Y-Y, et al. Use of etanercept to treat toxic epidermal necrolysis in a humanimmunodeficiency virus-positive patient. Dermatologica Sinica 31: 78-81, No. 2,Jun 2013. Available from: URL: http://dx.doi.org/10.1016/j.dsi.2012.06.005 -Taiwan 803089285