Department of Pharmacology, Postgraduate Institute of Medical Education and Research, DM-Resident Clinical Pharmacology, Chandigarh, India.
Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Br J Clin Pharmacol. 2021 Mar;87(3):1574-1577. doi: 10.1111/bcp.14533. Epub 2020 Sep 9.
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening immune-mediated hypersensitivity reactions. Various drugs, such as Non Steroidal Anti-inflammatory drugs (NSAIDS), allopurinol, anticonvulsants and antibiotics, have been implicated as triggering agent of SJS/TEN. Levamisole is frequently used as an antihelminthic and as an immunomodulator in cases of nephrotic syndrome. However, levamisole has not been reported as a trigger for SJS/TEN. The current case describes levamisole-induced TEN in a 15-year-old male who presented to emergency with erythematous lesions, blistering and denudation of skin involving up to 30% of body surface area. Algorithm of drug causality for epidermal necrolysis scoring was applied for causality assessment and a relationship was found to be "possible". Immediate withdrawal of levamisole along with a short course of corticosteroids and cyclosporine led to improvement in signs and symptoms. Clinicians should be aware of the possible association of levamisole and SJS/TEN.
史蒂文斯-约翰逊综合征（SJS）和中毒性表皮坏死松解症（TEN）是危及生命的免疫介导的过敏反应。多种药物，如非甾体抗炎药（NSAIDs）、别嘌醇、抗惊厥药和抗生素，已被认为是 SJS/TEN 的触发因素。左旋咪唑常用于治疗肾病综合征的驱虫药和免疫调节剂。然而，左旋咪唑尚未被报道为 SJS/TEN 的触发因素。本病例描述了一例 15 岁男性因左旋咪唑引起的 TEN，他因红斑性皮损、水疱和皮肤剥脱就诊，累及多达 30%的体表面积。应用表皮坏死松解评分的药物因果关系算法进行因果关系评估，发现存在“可能”关系。立即停用左旋咪唑，并短期使用皮质类固醇和环孢素治疗，症状和体征得到改善。临床医生应意识到左旋咪唑与 SJS/TEN 之间可能存在关联。
