Rapidly Progressing Severe Cutaneous Adverse Reaction With Acute Kidney Injury After Drug Exposure: An Uncommon Presentation

Toxic epidermal necrolysis syndrome (TEN) is a rare severe cutaneous adverse drug reaction that involves skin and mucous membranes. We describe a case of TEN presenting with stage III acute kidney injury, rhabdomyolysis, and acute respiratory failure likely triggered by allopurinol for recently diag...

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Bibliographic Details
Published inAmerican journal of therapeutics Vol. 23; no. 3; p. e916
Main Authors Rodgers, Bradley K, Kumar, Avinash B
Format Journal Article
LanguageEnglish
Published United States 01.05.2016
Subjects
Acute Kidney Injury - chemically induced
Allopurinol - adverse effects
Female
Gout - drug therapy
Gout Suppressants - adverse effects
Humans
Middle Aged
Respiratory Insufficiency - chemically induced
Rhabdomyolysis - chemically induced
Stevens-Johnson Syndrome - etiology
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Summary:Toxic epidermal necrolysis syndrome (TEN) is a rare severe cutaneous adverse drug reaction that involves skin and mucous membranes. We describe a case of TEN presenting with stage III acute kidney injury, rhabdomyolysis, and acute respiratory failure likely triggered by allopurinol for recently diagnosed gout. Prompt diagnosis, multidisciplinary management, including aggressive resuscitation, cardiorespiratory support, intravenous immunoglobulin therapy, and daily wound care resulted in a positive outcome despite a predicted mortality greater than 60%. Although allopurinol is a known triggering agent, TEN presenting with rhabdomyolysis and acute kidney injury is rare.
ISSN:1536-3686
DOI:10.1097/MJT.0000000000000070