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Toxic epidermal necrolysis in a child with lupus-associated pancreatitis

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Abstract

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening dermatological conditions that are characterized by mucosal erosions, epidermal detachments and erosions. The most common causes of SJS and TEN are drugs; other causes such as systemic lupus erythematosus (SLE), vaccinations and infections have been rarely implicated. We present the case of a 14-year-old female patient with acute pancreatitis as an initial manifestation of systemic lupus erythematosus, complicated by the toxic epidermal necrolysis with a fatal outcome. She initially presented with abdominal pain, fever, vomiting, and intolerance to oral intake and elevated pancreatic enzyme levels. Systemic lupus erythematosus was diagnosed secondary when her condition has been already complicated by the toxic epidermal necrolysis. The administration of corticosteroids and high doses of intravenous immunoglobulin did not lead to positive effects in the treatment of our patient.

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References

  1. Cetin GY, Sayar H, Ozkan F et al (2013) A case of toxic epidermal necrolysis-like skin lesions with systemic lupus erythematosus and review of the literature. Lupus 22(8):839–846. doi:10.1177/0961203313492242

    Article  Google Scholar 

  2. Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40(9):1725. doi:10.1002/1529-0131(199709)40:9&It;1725::AID-ART29>3.0CO;2-Y

    Article  CAS  PubMed  Google Scholar 

  3. Richer O, Ulinski T, Lemelle I et al (2007) Abdominal manifestations in childhood-onset systemic lupus erythematosus. Ann Rheum Dis 66(2):174–178. doi:10.1136/ard.2005.050070

    Article  CAS  PubMed  Google Scholar 

  4. Obermoser G, Sontheimer RD, Zelger B (2010) Overview of common, rare and atypical manifestations of cutaneous lupus erythematosus and histopathological correlates. Lupus 19(9):1050–1070. doi:10.1177/0961203310370048

    Article  CAS  PubMed  Google Scholar 

  5. Campos LM, Omori CH, Lotito AP et al (2010) Acute pancreatitis in juvenile systemic lupus erythematosus: a manifestation of macrophage activation syndrome? Lupus 19(14):1654–1658. doi:10.1177/0961203310378863

    Article  CAS  PubMed  Google Scholar 

  6. Paradela S, Martinez-Gomez W, Fernandez-Jorge B et al (2007) Toxic epidermal necrolysis-like acute cutaneous lupus erythematosus. Lupus 16(9):741–745. doi:10.1177/0961203307079498

    Article  CAS  PubMed  Google Scholar 

  7. Ting W, Stone MS, Racila D et al (2004) Toxic epidermal necrolysis-like acute cutaneous lupus erythematosus and the spectrum of the acute syndrome of apoptotic pan-epidermolysis (ASAP): a case report, concept review and proposal for new classification of lupus erythematosus vesiculobullous skin lesions. Lupus 13(12):941–950

    Article  CAS  PubMed  Google Scholar 

  8. Auquier-Dunant A, Mockenhaupt M, Naldi L et al (2002) Correlations between clinical patterns and causes of erythema multiforme majus, Stevens-Johnson syndrome and toxic epidermal necrolysis. Arch Dermatol 138(8):1019–1024

    Article  PubMed  Google Scholar 

  9. Yu J, Brandling-Bennett H, Co DO et al (2016) Toxic epidermal necrolysis-like cutaneous lupus in pediatric patients: a case series and review. Pediatrics 137(6):e20154497. doi:10.1542/peds.2015-4497

    Article  PubMed  Google Scholar 

  10. Torchia D, Romanelli P, Kardel FA (2012) Erythema multiforme and Stevens-Johnson syndrome/toxic epidermal necrolysis associated with lupus erythematosus. J Am Acad Dermatol 67(3):417–421. doi:10.1016/j.jaad.2011

    Article  PubMed  Google Scholar 

  11. Moallem HJ, Baqi N, Taningco G et al (2002) Systemic lupus erythematosus presenting as toxic epidermal necrolysis in an adolescent. Int Pediatr 17:31–33

    Google Scholar 

  12. Miralles ES, Nunez M, del Olmo N et al (1995) Ranitidine-related toxic epidermal necrolysis in a patient with idiopathic thrombocytopenic purpura. J Am Acad Dermatol 32:133–134

    Article  CAS  PubMed  Google Scholar 

  13. Velez A, Moreno JC (2000) Second case of ranitidine-related toxic epidermal necrolysis in a patient with idiopathic thrombocytopenic purpura. J Am Acad Dermatol 42:305

    Article  CAS  PubMed  Google Scholar 

  14. Reifenstein EC, Reifenstein GH (1939) A variable symptom complex of undetermined aetiology with fatal termination. Arch Intern Med 63:552–574

    Article  Google Scholar 

  15. Mockenhaupt M, Viboud C, Dunant A et al (2008) Stevens-Jonson syndrome and toxic epidermal necrolysis: assessment of medication risk with emphasis on recently marketed drugs. The EuroSKAR study. J Investig Dermatol 128(1):35–44. doi:10.1038/sj.jid.5701033

    Article  CAS  PubMed  Google Scholar 

  16. DeBanto JR, Goday PS, Pedroso MR et al (2002) Acute pancreatitis in children. Am J Gastroenterol 97(7):1726–1731. doi:10.1111/j.1572-0241.2002.05833.x

    Article  PubMed  Google Scholar 

  17. Lawson M, Dalzell AM, Couriel JM (2006) A rare cause of massive pleural effusion. Eur J Pediatr 165(1):73–75. doi:10.1007/s00431-005-1744-6

    Article  PubMed  Google Scholar 

  18. Ziemer M, Kardaun SH, Liss Y et al (2012) Stevens-Johnson syndrome and toxic epidermal necrolysis in patients with lupus erythematosus: a descriptive study of 17 cases from a national registry and review of the literature. Br J Dermatol 166(3):575–600. doi:10.1111/j.1365-2133.2011.10705.x

    Article  CAS  PubMed  Google Scholar 

  19. Worwick S, Cotliar J (2011) Stevens-Johnson syndrome and toxic epidermal necrolysis: a review of treatment options. Dermatol Ther 24(2):207–218. doi:10.1111/j.1529-8019.2011.01396.x

    Article  Google Scholar 

  20. Law EH, Leung M (2015) Corticosteroids in Stevens-Johnson syndrome/toxic epidermal necrolysis: current evidence and implications for future research. Ann Pharmacother 49(3):335–342. doi:10.1177/1060028014560012

    Article  CAS  PubMed  Google Scholar 

  21. Wang AS, Armstrong EJ, Armstrong AW (2013) Corticosteroids and wound healing: clinical considerations in the perioperative period. Am J Surg 206(3):410–417. doi:10.1016/j.amjsurg

    Article  CAS  PubMed  Google Scholar 

  22. Aihara M, Kano Y, Fujita H et al (2015) Efficacy of additional i.v.immunoglobulinto steroid therapy in Stevens-Johnson syndrome and toxic epidermal necrolysis. J Dermatol 42(8):768–777. doi:10.1111/1346-8138

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesia, Faculty of Medicine, University of Belgrade, Tirsova 10, Belgrade, Serbia

    Stevic Marija & Simic Dusica

  2. Department of Anesthesia, Faculty of Medicine, Clinical Centre Nis, University of Nis, Bulevar dr Zorana Djindjica 81, Nis, Serbia

    Budic Ivana

  3. Department of Gastroenterology, University Children’s Hospital, Svetogorska 11, Belgrade, Serbia

    Ristic Nina

  4. Department of Anesthesia, Royal Victoria Hospital, 274 Grosnor RD, Belfast, BT, 12 6BA, UK

    Nenadic Dragan

  5. Department of Minimally Invasive Surgery, Zvezdara University Center, Dimitrija Tucovica 161, Belgrade, Serbia

    Bokun Zlatko

  6. Department of Abdominal surgery, University Children’s Hospital, Tirsova 10, Belgrade, Serbia

    Jovanovic Branislav & Pejanovic Jelena

Authors
  1. Stevic Marija
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  2. Budic Ivana
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  3. Ristic Nina
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  4. Nenadic Dragan
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  5. Bokun Zlatko
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  6. Jovanovic Branislav
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  7. Pejanovic Jelena
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  8. Simic Dusica
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Corresponding author

Correspondence to Stevic Marija.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Written informed consent was obtained from the father.

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Marija, S., Ivana, B., Nina, R. et al. Toxic epidermal necrolysis in a child with lupus-associated pancreatitis. Rheumatol Int 37, 1221–1226 (2017). https://doi.org/10.1007/s00296-017-3677-6

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  • DOI: https://doi.org/10.1007/s00296-017-3677-6

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