Stevens-Johnson syndrome induced by carbamazepine and amitriptyline in diabetic patient: a case report

Authors

  • Agus Dody Pranata Suadi Putra Department of Internal Medicine, Wangaya Regional Hospital, Denpasar, Bali, Indonesia
  • Ketut Suryana Department of Internal Medicine, Wangaya Regional Hospital, Denpasar, Bali, Indonesia
  • Dewi Catur Wulandari Department of Internal Medicine, Wangaya Regional Hospital, Denpasar, Bali, Indonesia
  • Ida Ayu Uttari Priyadarshini Department of Internal Medicine, Wangaya Regional Hospital, Denpasar, Bali, Indonesia

DOI:

https://doi.org/10.18203/2349-3933.ijam20221845

Keywords:

Steven-Johnson syndrome, Diabetes mellitus, Immune reactions

Abstract

Stevens-Johnson syndrome (SJS) is systemic immune reactions (type IV hypersensitivity) that are usually present by blistering and erosions of skin and mucous membranes with involvement of multiple organ systems. The incidence of SJS is rare, with the common comorbidities are diabetes mellitus, epilepsy, hypertension, and stroke. This condition is associated with systemic proinflammatory state. Diabetes mellitus is a metabolic disorder that is characterized by abnormally elevated levels of blood glucose due to glucose intolerance, hyperglycemia, and impaired insulin secretion. Nowadays, pathogenesis of diabetes is considered to be dysregulation of immune factors that are recognized as important etiological components in the development of insulin resistance. We report a case of a 30-years-old man with fever and sore throat, who had type 2 diabetes mellitus (T2DM) and used carbamazepine and amitriptyline for diabetic neuropathy, then followed by redness and blistering on his lips, palates, face, and trunk which subsequently diagnosed with SJS.

References

Akyol A, Ozkul A. Tosun A, Sendur N. Steven-Johnson Syndrome Prevalence due to Antiepileptic Drug Therapy at Aydin Province University Medical Faculty Hospital. Turkish Epilepsy Society. 2017;23(1):25-8.

Hsu DY, Brieva J, Silverberg NB, Silverberg JI. Morbidity and Mortality of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in United States Adults. J Invest Dermatol. 2016;136(7):1387-97.

Mockenhaupt M. Epidermal Necrolysis (Stevens- Johnson Syndrome and Toxic Epidermal Necrolysis). In: Kang S, Bruckner AL, Enk AH, Margolis DJ, Orringer JS, eds Fitzpatrick’s Dermatology. 9th ed. New York, NY: McGraw-Hill; 2019: 733-748.

Issac WA, Damayanti, Fatimah N, Hidaanti AN. The Profiles of Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) Patients in Tertiary Hospital. Periodical of Dermatol Venereol. 2021;33(2):116-22.

Micheletti RG, Chiesa-Fuxench Z, Noe MH, Stephen S, Aleshin M, Agarwal A, et al. Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: A Multicenter Retrospective Study of 377 Adult Patients from the United States. J Invest Dermatol. 2018;138(11):2315-21.

Chung WH, Hung SL. Recent Advance in the Genetics and Immunology of Steven-Johnson Syndrome and Toxic Epidermal Necrolysis. J Dermatol Sci. 2012;66:190-6.

Wei CY, Chung WH, Huang HW, Chen YT, Hung SL. Direct Interaction between HLA-B and Carbamazepine Activates T Cells in Patients with Steven-Johnson Syndrome. J Allergy Clin Immunol. 2012;129(6):1562-9.

Selvia, Wardhany II. The Importance of Accurate Anamnesis in Determining Suspected Drugs Causing of Oral Manifestation of Stevens Johnson Syndrome-Toxic Epidermal Necrolysis (Case Report). UIP Health Med. 2016;1(1):34-8.

Ezaldein H, Totonchy M, Chow C, Samuel A, Ventura A. The Effect of Comorbidities on Overall Mortality in Stevens-Johnson Syndrome: An Analysis of the Nationwide Inpatient Sample. Dermatol Online J. 2017;23(4):1-7.

Zhou T, Hu Z, Yang S, Sun L, Zhenxiang Y, Wang G. Role of Adaptive and Innate Immunity in Type 2 Diabetes Mellitus. Hindawi J Diabet Research. 2018;1-9.

Rajana VK. Immune Dysfunction in Diabetes Mellitus (DM). Int J Health Sci Res. 2017;7(12):256-75.

Rehman K, Akash M, Liaqat A. Role of Interleukin-6 in Development of Insulin Resistance and Type 2 Diabetes Mellitus. Eukaryotic Gene Expression. 2017;27(3):229-36.

Geerlings S, Hoepelman A. Immune Dysfunction in Patients with Diabetes Mellitus (DM). FEMS Immunol Med Microbiol. 1999;26:259-65.

Gkkoglou P, Bohm M. Skin Disorders in Diabetes Mellitus. J German Soc Dermatol. 2014;1210:847-62.

Makrantonaki E, Jiang D, Hossini AM, Nikolakis G, Wlaschek M, Scharffetter-Kochanek K, et al. Diabetes mellitus and the skin. Rev Endocr Metab Disord. 2016;17(3):269-82.

Nurdin, Kalma, Hasnawati, Nasir H. Profile of The Neutrophil Lymphocyte Ratio (NLR) in Type-2 Diabetes Mellitus. J. Media Analis Kesehatan. 2021;12(1):64-8.

Downloads

Published

2022-07-25

Issue

Section

Case Reports