Rossi Carlo Maria, Beretta Flavio Niccolò, Traverso Grazia, Mancarella Sandro, Zenoni Davide
Dipartimento di Area Medica, U.O. Medicina Interna, ASST Nord Milano, Ospedale Edoardo Bassini, Via Massimo Gorki 50, 20092 Cinisello Balsamo (MI), Italy.
Scuola di Specializzazione in Farmacia Ospedaliera, Università degli Studi di Milano, Via L. Mangiagalli 25, 20133 Milan, MI Italy.
Clin Mol Allergy. 2020 Oct 6;18:19. doi: 10.1186/s12948-020-00133-6. eCollection 2020.
Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) is the most Serious Cutaneous Adverse Reaction (SCAR) often with a fatal outcome. Coronavirus Disease (COVID-19) is caused by Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-COV2) and is an emergent pandemic for which no cure exist at the moment. Several drugs have been tried often with scant clinical evidence and safety.
Here we report the case of 78-years-old woman with cardiometabolic syndrome and COVID-19. A multidrug regimen including others hydroxychloroquine, antibiotics, dexamethasone and paracetamol, low-molecular-weight-heparin and potassium canrenoate was started. After almost 3 weeks, the patient started to display a violaceous rash initially involving the flexural folds atypical targetoid lesions and showing a very fast extension, blister formation and skin detachments of approximately 70% of the total body surface area and mucous membranes involvement consistent with toxic epidermal necrolysis (TEN). The ALDEN algorithm was calculated inserting all drugs given to the patient in the 28 days preceding the onset of the skin manifestations. The highest score retrieved was for hydroxychloroquine. Other less suspicious drugs were piperacillin/tazobactam, ceftriaxone and levofloxacin.
To our knowledge, this is the first case of TEN in a patient suffering from COVID-19 probably associated with hydroxychloroquine. Given the activation of the immune system syndrome induced by the virus and the widespread off-label use of this drug, we suggest a careful monitoring of skin and mucous membranes in all COVID-19 positive patients treated with hydroxychloroquine in order to early detect early signs of toxicities.
史蒂文斯 - 约翰逊综合征/中毒性表皮坏死松解症（SJS/TEN）是最严重的皮肤不良反应（SCAR），通常会导致致命后果。冠状病毒病（COVID-19）由严重急性呼吸综合征冠状病毒2（SARS-COV2）引起，是一种目前尚无治愈方法的突发大流行病。人们尝试了多种药物，但往往缺乏临床证据和安全性。
在此，我们报告一例患有心脏代谢综合征和COVID-19的78岁女性病例。开始使用包括羟氯喹、抗生素、地塞米松、对乙酰氨基酚、低分子量肝素和坎利酸钾在内的多种药物治疗方案。近3周后，患者开始出现紫红色皮疹，最初累及屈侧褶皱处，有非典型靶样皮损，并迅速扩展，形成水疱，皮肤剥脱面积约占全身表面积的70%，伴有黏膜受累，符合中毒性表皮坏死松解症（TEN）。采用ALDEN算法，将患者在皮肤表现出现前28天内使用的所有药物输入计算。得分最高的是羟氯喹。其他可疑性较低的药物是哌拉西林/他唑巴坦、头孢曲松和左氧氟沙星。
据我们所知，这是首例在COVID-19患者中发生的可能与羟氯喹相关的TEN病例。鉴于病毒诱导的免疫系统综合征的激活以及该药物广泛的超说明书使用，我们建议对所有接受羟氯喹治疗的COVID-19阳性患者仔细监测皮肤和黏膜，以便早期发现毒性的早期迹象。
