Analysis of One Case of 木 Toxic Epidermal Necrolysis Induced by Aspirin

doi:10.19803/j.1672-8629.2020.04.11

Abstract

Abstract: Objective To probe the experience learned from the treatment of toxic epidermal necrolysis (TEN) induced by aspirin. Methods The possible causes of TEN and treatment protocols were studied and summarized by analyzing the medical records of a patient in June 2019. Results The patient needed oral anticoagulation because of percutaneous coronary intervention (PCI) two years ago. On the second day after taking oral aspirin, the patient developed red rash before some of the maculae were gradually fused into a large area. Over the next few days, blisters appeared and were ulcerated, and epidermis was exfoliated. TEN induced by aspirin was considered and aspirin was immediately stopped so that the symptoms on the patient's skin were relieved gradually via anti-allergic therapy and symptomatic supportive treatment. Conclusion TEN may be induced by aspirin. Early identification, suspension of suspected medicine and effective treatment are the key to cure of drug-induced TEN.

Key words: aspirin, TEN, adverse drug reaction, literature review

CLC Number:

R952

DU Xiu1, CAO Yun. Analysis of One Case of 木 Toxic Epidermal Necrolysis Induced by Aspirin[J]. Chinese Journal of Pharmacovigilance, 2020, 17(4): 245-248.

References

[1] Rustam Al-Shahi Salman, David P Minks, Dipayan Mitra, et al.Effects of antipla-telet therapy on stroke risk by brain imagingfeatures of intracerebral haemorrhage and cerebral small vesseldiseases: subgroup analyses of the RESTART randomised,open-label trial[J]. The Lancet Neurology, 2019, 18(7): 643-652.
[2] Rustam Al-Shahi Salman, MS Dennis, PAG Sandercock, et al.Effects of antiplat-elet therapy after stroke due to intracerebralhaemorrhage (RESTART): a randomi-sed, open-label trial[J].The Lancet, 2019, 393(10191): 2613-2623.
[3] Donna K. Arnett, Roger S. Blumenthal, Michelle A.Albert, et al.2019ACC/AHA Guideline on the Primary Prevention of Cardio-vascular Disease[J]. Journal of the American College of Cardiology,2019, 74(10): 1376-1414.
[4] 李才正,苗佳. 阿司匹林的临床应用进展[J]. 华西医学, 2012,27(7): 988-991.
[5] 董怡. 对FDA要求修改非甾体抗炎药说明书的思考[J]. 中国药物警戒, 2005, 2(3): 156-157.
[6] 罗兴献, 刘一, 薛学财, 等. 非甾体抗炎药致重症药疹文献汇总分析[J]. 中国医院药学杂志, 2017, 37(21):2155-2159.
[7] Settipane RA,Constantine HP, Settipane GA.Aspirin intol-erance and recurrent urticaria in normal adults and children[J].Allergy, 1980, 35(2): 149-154.
[8] 谢建翔, 张丽. 重症药疹297 例分析[J]. 中国医院药学杂志,2014, 34(3): 247-249.
[9] Lyell A.Toxic epidermal necrolysis (the scalded skin syndrome):a reappraisal[J]. The British journal dermatology,1979, 100(1):69-86.
[10] 李飞鸥, 汪芳, 华潞, 等. 阿司匹林致哮喘1例[J]. 中国药物警戒, 2005, 2(2): 93-94.
[11] Kowalski M L, Asero R, Bavbek S, et al.Classification and prac-tical approach to the diagnosis and management of hypersensitivityto nonsteroidal anti-inflammatory drugs[J]. Allergy, 2013,68(10): 1219-1232.
[12] Lee SY, Nam YH, Koh YI, et al.Phenotypes of Severe CutaneousAdverse R eactions Caused by Nonsteroidal Anti-inflammatoryDrugs[J]. Allergy Asthma Immunol Res, 2019, 11(2): 212-221.
[13] Martinez-Cabriales SA, Gomez-Flores M, Ocampocandlani J.News in severe clinical adverse drug reactions: Stevens- Johnsonsyndrome(SJS) and toxic epidermal necrolysis(TEN)[J]. GacetaMedica de Mexico, 2015, 151(6): 777-787.
[14] Trautmann A, Akdis M, Schmid-Grendel Meier P, et al.Targetingkeratinocyte apoptosis in the treatment of atopic dermatitis andallergic contact dermatitis[J]. Journal of Allergy Clinical Immunol,2001, 108(5) : 839-846.
[15] Mario Sa´nchez-Borges, MD. Clinical management of nonsteroidalanti-inflammatory drug hypersensitivity[J]. Word AllergyOrganization, 2008, 1(2): 29-33.
[16] French LE, Trent TJ, Kerdel FA.Use of intravenous immunog-lobulin in toxic epidermal necrolysis and Stevens Johnsonsyndrome: our current understanding[J]. Int Immunopharmacol,2006, 6(4): 543-549.
[17] Schneider JA, Cohen PR.Stevens-Johnson syndrome and toxicepidermal necrolysis: A concise review with a comprehensivesummary of therapeutic interventions emphasizing supportivemeasures[J]. Advances in Therapy, 2017, 34(6) : 1-10.
[18] Hunger RE, Hunziker T, Buettiker U, et al.Rapid resolution oftoxic epidermal necrolysis with anti-tnf-alpha treatment[J].Journal of Allergy Clinical Immunol, 2005, 116(4) : 923-924.
[19] Paquetp, pierard GE. Would cyclosporin a be beneficial to mitigatedrug-induced toxic epidermal necrolysis?[J]. Dermatology, 1999,198(2) : 198-202.
[20] Hsu DY, Brieva J, Silverberg NB, et al.Morbidity and mortalityof Stevens- Johnson syndrome and toxic epidermal necrolysis inUnited States adults[J]. Journal of Investigative Dermatology,2016, 136(7): 1387-1397.