Chin Laura D, MacGillivary Michael L, Purdy Kerri S, Kirshen Carly
Division of Dermatology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
Division of Dermatology, Department of Medicine, Dalhousie University, Halifax, NS, Canada.
SAGE Open Med Case Rep. 2024 Dec 19;12:2050313X241307097. doi: 10.1177/2050313X241307097. eCollection 2024.
Stevens-Johnson syndrome and drug reaction with eosinophilia and systemic symptoms are severe cutaneous adverse reactions to drugs that are generally considered distinct entities. In addition to identifying the offending medication, distinguishing between these diagnoses is important, as they have differing treatment regimens and prognoses. Distinction between severe cutaneous adverse reactions, particularly in the early stages of disease, can be difficult, and overlapping conditions have been reported in the literature. We present two cases of severe cutaneous adverse reaction, one following initiation of carbamazepine and the other lamotrigine, with extensive mucosal involvement and epidermal detachment, initially diagnosed as Stevens-Johnson syndrome. Despite the use of cyclosporine and repeated doses of etanercept, both cases evolved to have significant edema of the face and extremities, palmar and plantar involvement, and rapid response to systemic corticosteroids, which is more in-keeping with drug reaction with eosinophilia and systemic symptoms. We aim to help clinicians gain awareness of Stevens-Johnson syndrome/drug reaction with eosinophilia and systemic symptoms overlap which may aid diagnosis and guide treatment.
史蒂文斯-约翰逊综合征以及伴有嗜酸性粒细胞增多和全身症状的药物反应是对药物的严重皮肤不良反应，通常被认为是不同的病症。除了确定致病药物外，区分这些诊断很重要，因为它们有不同的治疗方案和预后。区分严重皮肤不良反应，尤其是在疾病早期，可能很困难，并且文献中已报道了重叠情况。我们报告两例严重皮肤不良反应病例，一例在开始服用卡马西平后出现，另一例在开始服用拉莫三嗪后出现，伴有广泛黏膜受累和表皮剥脱，最初诊断为史蒂文斯-约翰逊综合征。尽管使用了环孢素并多次注射依那西普，但两例病例均发展为面部和四肢明显水肿、掌跖受累，且对全身皮质类固醇有快速反应，这更符合伴有嗜酸性粒细胞增多和全身症状的药物反应。我们旨在帮助临床医生认识到史蒂文斯-约翰逊综合征/伴有嗜酸性粒细胞增多和全身症状的药物反应重叠情况，这可能有助于诊断并指导治疗。
