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World Journal of Clinical Cases 2022年第18期10卷 6110-6118页

作者： Jing-Yi Wu Kai Kang Jing Yi Bin Yang Department of Thoracic Oncology Hubei Cancer HospitalTongji Medical CollegeHuazhong University of Science and TechonologyWuhan 430000Hubei ProvinceChina Department of Thoracic Oncology Surgery Hubei Cancer HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430070Hubei ProvinceChina

BACKGROUND For advanced lung squamous cell carcinoma,immune checkpoint inhibitors(ICIs)have been regarded as one of the optimal therapies.While immune-related adverse events(ir AEs)are common in ICI treatment,cutaneous toxicities are among the most common ir AEs.Most immune-related skin toxicity grades are low,and the prognosis is good.However,stevens-johnson syndrome(SJS)is a rare but extremely severe cutaneous adverse drug reaction with high mortality.CASE SUMMARY We report a rare case of SJS induced by pembrolizumab.The case involved a 68-year-old female who was diagnosed with advanced squamous cell carcinoma of the lung.SJS appeared after one cycle of immunotherapy combined with chemotherapy.After treatment with prednisone hormone symptoms,antiinfection,gamma globulin,and antipruritic agents,the skin toxicity of the patients gradually decreased and eventually disappeared.Although the antitumor treatment was stopped due to serious adverse reactions,the tumor of the patient remained stable for nearly half a year after one cycle of immune therapy combined with chemotherapy,which also corroborates the delayed effect of immunotherapy.CONCLUSION We believe our report can provide some references for the treatment of SJS and the treatment of immune-related adverse reactions.

关键词： Pembrolizumab stevens-johnson syndrome Advanced squamous cell carcinoma Lung Immune-related adverse events Case report

Cohort study of patients with stevens-johnson syndrome and toxic epidermal necrolysis in China:evaluation of risk models and new predictor of pulmonary consolidation on computed tomography

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Frontiers of Medicine 2021年第4期15卷 585-593页

作者： Yanhong Shou Lu Yang Yongsheng Yang Xiaohua Zhu Feng Li Bo Yin Yingyan Zheng Jinhua Xu Department of Dermatology Huashan HospitalFudan UniversityShanghai 200040China Department of Radiology Huashan HospitalFudan UniversityShanghai 200040China Shanghai Institute of Dermatology Shanghai 200040China

stevens-johnson syndrome(SJS)and toxic epidermal necrolysis(TEN)are rare but severe diseases.This study aimed to validate the predictive ability of risk models in patients with SJS/TEN and propose possible refinement in China.Patients in the Department of Dermatology of Huashan Hospital from January 2008 to January 2019 were included.Results showed that the severity-of-illness score for TEN(SCORTEN)had a good discrimination(area under the receiver operating characteristic curve(AUC),0.78),and it was superior to auxiliary score(AS)and ABCD-10,which indicates age,bicarbonate level,cancer,dialysis,and 10%involved body surface area(AUC,0.69 and 0.68,respectively).The calibration of SCORTEN(Hosmer-Lemeshow goodness-of-fit test,P=0.69)was also better than that of AS(P=0.25)and ABCD-10(P=0.55).SCORTEN and ABCD-10 were similar(Brier score(BS),0.04 and 0.04)in terms of accuracy of predictions.In addition,the imaging appearance of pulmonary consolidation on computed tomography was associated with high mortality.Refined models were formed using the variables and this imaging appearance.The refined AS and ABCD-10 models were similar in discrimination compared with the original SCORTEN(0.74 vs.0.78,P=0.23;0.74 vs.0.78,P=0.30,respectively).Therefore,SCORTEN showed good discrimination performance,calibration,and accuracy,and refined AS or ABCD-10 model may be an option when SCORTEN variables are not available.

关键词： stevens-johnson syndrome toxic epidermal necrolysis auxiliary score ABCD-10 pulmonary consolidation

stevens-johnson syndrome/toxic epidermal necrolysis successfully treated with Chinese herbal medicine Pi-Yan-Ning: A case report

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Journal of Integrative Medicine 2021年第6期19卷 555-560页

作者： Shu-yi Chen Qun-wei Chen Liu-mei Shou Hong Pan Shan-ming Ruan Zhe-hao Liang Qi-jin Shu Department of Oncology the First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhou 310006Zhejiang ProvinceChina Department of Medical Ultrasonics the First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhou 310006Zhejiang ProvinceChina

stevens-johnson syndrome/toxic epidermal necrolysis(SJS/TEN)is a rare adverse cutaneous reaction with a low incidence and high mortality.Despite posing a serious threat to patients’health and lives,there is no high-quality evidence for a standard treatment regimen.Here we report the case of a 62-year-old man with stage IV pancreatic cancer who experienced immunotherapy-induced SJS/TEN.After consensus-based regular treatments at a local hospital,his symptoms became worse.Thus,he consented to receive Chinese herbal medicine(CHM)therapy.The affected parts of the patient were treated with the CHM Pi-Yan-Ning which was applied externally for 20 min twice a day.After 7 days of treatment,the dead skin began peeling away from the former lesions that had covered his hands,feet,and lips,indicating that skin had regenerated.After 12 days of treatment,the patient’s skin was completely recovered.In this case,SJS/TEN was successfully treated with Pi-Yan-Ning,suggesting that there might be tremendous potential for the use of Pi-Yan-Ning in the treatment of severe skin reactions to drug treatments.Further basic investigations and clinical trials to explore the mechanism and efficacy are needed.

关键词： Chinese herbal medicine Immunotherapy stevens-johnson syndrome Toxic epidermal necrolysis Case report

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Retrospective Analysis of stevens-johnson syndrome and Toxic Epidermal Necrolysis in 88 Chinese Patients

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Chinese Medical Journal 2017年第9期130卷 1062-1068页

作者： Li Wang Xue-Ling Mei Department of Dermatology Allergy and Clinical Immunology Centre Beijing Friendship Hospital Capital Medical University Beijing 100050 China

Background： stevens-johnson syndrome （SJS） and toxic epidennal necrolysis （TEN） are life-threatening diseases with high mortality rates. This study was designed to analyze the pathogenic factors, clinical manifestations, complications, treatment, and prognosis of SJS/TEN and to explore the differences between surviving and deceased patients. Methods： SJS/TEN patients admitted to Beijing Friendship Hospital from January 2006 to December 2015 were included in the study. Patients＇ data were retrospectively analyzed. Comparative studies were performed on the survival group and the deceased group, and Fisher＇s exact probability test was used for statistical analysis. Results： Among the 88 patients included, 40 （45.5%） were male with a mean age of 45 - 18 years. Forty-eight （54.5%） had SJS, 34 （38.6%） had SJS/TEN, and 6 （6.8%） had TEN. Fifty-three （60.2%） cases were caused by medications, mainly antibiotics （n = 24） followed by traditional Chinese medicines 97 - 7）. Forty-two cases （47.7%） developed visceral damage. Eighty-two patients improved or recovered and were discharged from hospital, and six patients died. Comparative studies on the survival group and the deceased group showed that the presence of malignant tumor （Z2 = 27.969, P 〈 0.001）, connective tissue diseases （x^2 - 9.187, P = 0.002）, previous abnormal liver/kidney functions （x^2 = 6.006, P = 0.014）, heart rate 〉100 times/rain （x^2 = 6.347, P = 0.012）, detached skin area 〉20% （x^2 = 5.594, P = 0.018）, concurrent mucosal involvement at the mouth, eyes, and external genitals （Z2 = 4.945, P = 0.026）, subsequent accompanying liver/kidney damage （x^ = 11.839, P = 0.001, and x^2 = 36.302, P 〈 0.00 l, respectively）, and SCORTEN score 〉2 （x^2 = 37.148, P 〈 0.001 ） increased the risk of death. Conclusions： SJS/TEN is mainly caused by medications, and nearly half of patients develop visceral damage. Multiple factors increase the mortality risk.

关键词： Mortality Relative Risk stevens-johnson syndrome stevens-johnson syndrome/Toxic Epidermal Necrolysis Overlap Toxic Epidernlal Necrolysis

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stevens-johnson syndrome and concurrent hand foot syndrome during treatment with capecitabine:A case report

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World Journal of Clinical Cases 2021年第17期9卷 4279-4284页

作者： Ha Rim Ahn Sang-Kyung Lee Hyun Jo Youn Seok-Kweon Yun Il-Jae Lee Division of Breast and Thyroid Surgery Department of SurgeryJeonbuk National UniversityJeonju 54907South Korea Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital Jeonju 54907South Korea Department of Dermatology Jeonbuk National University Medical SchoolJeonju 54907South Korea

BACKGROUND Capecitabine is used in combination with lapatinib as palliative treatment for human epidermal growth factor receptor 2-positive metastatic breast cancer.The most frequently reported adverse events attributed to capecitabine include diarrhea,hyperbilirubinemia,and hand-foot syndrome(HFS).A number of cutaneous adverse events have been attributed to capecitabine,including stevens-johnson syndrome(SJS)as a rare and potentially life-threatening mucocutaneous condition.We report the first case involving concurrent SJS and HFS after capecitabine and lapatinib treatment.CASE SUMMARY A 70-year-old woman with a history of breast cancer treatment visited our hospital for evaluation of painful skin lesions.Six weeks earlier,she had been prescribed capecitabine plus lapatinib as treatment for metastatic breast cancer.She subsequently developed worsening erythema and bullae on her palms and soles,as well as reddish macules on her back and chest wall.Histopathological evaluation of the chest wall lesions revealed extensive eosinophilic epidermal necrosis and separation of the epidermis from the dermis.The capecitabine plus lapatinib treatment was discontinued immediately and treatment was started using systemic steroids.This treatment resolved most lesions,although the lesions on her palms and soles required Vaseline gauze dressings,which resulted in reepithelialization.Therefore,we determined that the patient had concurrent SJS and HFS.Although the dermatological problems resolved,the patient ultimately died because of multiple organ failure.CONCLUSION Oral capecitabine treatment carries a risk of both HFS and also life-threatening adverse cutaneous drug reactions,such as SJS.

关键词： stevens-johnson syndrome Hand-Foot syndrome Palliative treatment Capecitabine Breast neoplasms Case report

stevens-johnson syndrome complicated by obstructive uropathy,pneumothorax,and pneumomediastinum:a case report and literature review

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Burns & Trauma 2019年第1期7卷 125-131页

作者： Damian Bruce-Hickman Xiao Jiang Joshua Jin-Ping Thia Amit Kansal Department of Intensive Care Medicine Ng Teng Fong HospitalSingaporeSingap

Background:stevens-johnson syndrome(SJS)is an acute mucocutaneous eruption with blisters of the skin and haemorrhagic erosions of mucous membranes.This report describes air-leak syndrome and obstructive uropathy occurring simultaneously in a teenage patient affected by SJS.Case presentation:A 17-year-old Malay female with SJS suffered from bilateral pneumothoraces,pneumomediastinum,and obstructive uropathy as early complications of her disease.She required intubation,chest tube insertion,and bilateral ureteric stenting as part of her intensive care management.These extracutaneous complications of renal and pulmonary systems were likely secondary to widespread epithelial detachment.Conclusion:Despite paucity of cases in adult literature,post-renal causes for acute kidney injury must be considered in SJS,especially in the setting of gross haematuria.Bedside point-of-care ultrasonography may be a useful tool for excluding obstructive uropathy.Pneumothorax is a rare but documented complication of SJS in paediatric cases and,to a lesser extent,adult patients.Extra care should be exercised when caring for mechanically ventilated patients suffering from SJS.

关键词： stevens-johnson syndrome Obstructive uropathy Ureteric stenting Pneumothorax Pneumomediastinum

Osteo-odonto keratoprosthesis in stevens-johnson syndrome:a case report

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International Journal of Ophthalmology(English edition) 2011年第2期4卷 212-215页

作者： Reddy SC Tajunisah I Tan D T Department of Ophthalmology Faculty of MedicineUniversity of Malaya Corneal services department Singapore National Eye Centre & Department of OphthalmologyYong Loo Lin School of MedicineNational University of Singapore

·AIM:To report a successful osteo-odonto keratoprosthesis(OOKP) procedure in a case of end stage of corneal blindness due to stevens-johnson syndrome (SJS).·METHODS:An interventional case report.·RESULTS:We describe a 35-year-old Indian woman,a known case of SJS with bilateral dry eyes and corneal blindness (failed corneal graft with vascularised total corneal opacity in the right eye and non-healing corneal ulcer in the left eye).Vision was hand movement only in both eyes.The corneal ulcer healed with medical treatment resulting in vascularised total corneal opacity with no improvement in vision.OOKP was performed in the right eye and the vision was improved from hand movement to 6/6.The same vision was maintained in the right eye at the last follow-up 5 years after surgery.·CONCLUSION:OOKP provides good visual rehabilitation with long-term anatomically stable prosthesis in patients with end-stage of ocular surface disorders and corneal blindness secondary to SJS.·

关键词： osteo-odonto keratoprosthesis stevens-johnson syndrome corneal blindness

Association of HLA-B*1502 and*1511 Allele with Antiepileptic Drug-induced stevens-johnson syndrome in Central China

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2014年第1期34卷 146-150页

作者：孙丹余春华刘智胜何雪莲胡家胜吴革菲毛冰吴舒华项慧慧 Department of Pediatric Neurology Wuhan Children’s Hospital Department of Science Research and Education Wuhan Children’s Hospital Department of Central Laboratory Wuhan Children’s Hospital

Previous studies have demonstrated a strong association between carbamazepine（CBZ）-induced stevens-johnson syndrome（SJS） and HLA-B 1502 in Han Chinese. Here, we extended the study of HLA-B 1502 susceptibility to two different antiepileptic drugs, oxcarbazepine（OXC） and phenobabital（PB）. In addition, we genotyped HLA-B 1511 in a case of CBZ-induced SJS with genotype negative for HLA-B 1502. The presence of HLA-B 1502 was determined using polymerase chain reaction with sequence-specific primers（PCR-SSP）. Moreover, we genotyped HLA-B 1502 in 17 cases of antiepileptic drugs（AEDs）-induced cutaneous adverse drug reactions（cADRs）, in comparison with AEDs-tolerant（n=32） and normal controls（n=38） in the central region of China. The data showed that HLA-B 1502 was positive in 5 of 6 cases of AEDs-induced SJS（4 CBZ, 1 OXC and 1 PB）, which was significantly more frequent than AEDs-tolerant（2/32, 18 CBZ, 6 PB and 8 OXC） and normal controls（3/38）. Compared with AEDs-tolerant and normal controls, the OR for patients carrying the HLA-B 1502 with AEDs-induced SJS was 6.25（95% CI： 1.06–36.74） and 4.86（95% CI： 1.01–23.47）. The sensitivity and specificity of HLA-B 1502 for prediction of AEDs-induced SJS were 71.4%. The sensitivity and specificity of HLA-B 1502 for prediction of CBZ-induced SJS were 60% and 94%. HLA-B 1502 was not found in 11 children with maculopapular exanthema（MPE）（n=9） and hypersensitivity syndrome（HSS）（n=2）. However, we also found one case of CBZ-induced SJS who was negative for HLA-B 1502 but carried HLA-B 1511. It was suggested that the association between the CBZ-induced SJS and HLA-B 1502 allele in Han Chinese children can extend to other aromatic AEDs including OXC and PB related SJS. HLA-B 1511 may be a risk factor for some patients with CBZ-induced SJS negative for HLA-B 1502.

关键词： stevens-johnson syndrome antiepileptic drugs children HLA-B 1511 HLA-B 1502

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Enzalutamide Associated with stevens-johnson syndrome/Toxic Epidermal Necrolysis (SJS/TEN) Overlap: A Case Report

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Surgical Science 2021年第12期12卷 421-426页

作者： Sharjeel Israr Christopher R. Mellon Haley J. Springs Asia N. Quan Marc R. Matthews Department of General Surgery Creighton University School of Medicine Phoenix Campus St. Joseph Hospital and Medical Center Phoenix AZ USA Honor Health Medical Center Department of Surgery Scottsdale AZ USA Department of General Surgery Honor Health John C. Lincoln Medical Center Phoenix AZ USA Department of Pharmacy Valleywise Health Medical Center Phoenix AZ USA The Arizona Burn Center Phoenix AZ USA

Enzalutamide is a hormonal therapy that blocks the action of androgens, such as testosterone in the treatment of metastatic castration-resistant prostate cancer. stevens-johnson syndrome and toxic epidermal necrolysis... 详细信息

Enzalutamide is a hormonal therapy that blocks the action of androgens, such as testosterone in the treatment of metastatic castration-resistant prostate cancer. Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) overlap and are part of an adverse drug reaction continuum of disease, in which there is a 10% - 30% involvement of the skin surface with mucositis, blisters, skin slough, and a macular rash. A 66-year-old male was treated with enzalutamide for metastatic prostate cancer and developed SJS/TEN overlap with 25% total body surface area skin involvement. The patient received a seven-day course of cyclosporine to which he responded by re-epithelialization but succumbed to multi-organ failure. While SJS/TEN has been reported with apalutamide, to our knowledge, this is the first case of SJS/TEN overlap with enzalutamide.

关键词： Prostate Cancer Enzalutamide stevens-johnson syndrome Toxic Epidermal Necrolysis SJS/TEN

A Case of Multiple Sexually Transmitted Diseases (STDs),with stevens-johnson syndrome and Mediastinal Tumor

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Chinese Journal of Sexually Transmitted Infections 2002年第1期2卷 46-48页

作者：陈玉平熊琳冉玉平童燕芳 Dept of Dermato-venereology West China Hospital of Sichuan University MD Dept of demato-venereology the Affiliated Hospital of Panzhihua Steel Group Panzhihua of Sichuan Province Dept of Dermato-venereology Hospital of Liupanshui city Liupanshui of Guizhou Province Chengdu 610041 Sichuan China 617023 China 553001 China.

A 29-year-old man was admitted for erythema,papules and erosions. Erosions and purulent secretions wereseen in the circumference of the mouth, eyes, oralmucosa,tongue, and preputium. Conjunctivas were swollenand the urethral orifice was red, both were accompanied bypurulent secretions. Multiple vesicles were shown in the penis.The patient was diagnosed with: ① stevens-johnsonsyndrome; ② gonococcal ophthalmoblennorrhea; ③nongonococcal urethritis, gonococcal urethritis;④genitalherpes;⑤mediastinal tumor.

关键词： stevens-johnson syndrome Sexually transmitted diseases(STD) mediastinal tumor