When the Drug Becomes Toxic!: Lyell Syndrome in a Moroccan Context

• Published in: Drug safety Vol. 45; no. 10; p. 1277
• Main Authors: Imane, Z, Ouardi, A, Ababou, K, Gharbi, A E, Bencheikh, R S, Bousliman, Y, Tadlaoui, Y
• Format: Journal Article
• Language: English
• Published: Auckland Springer Nature B.V 01.10.2022
• Subjects: Amoxicillin; Analgesics; Antibiotics; Drugs; Genetic factors; Immunology; Lesions; Medical treatment; Paracetamol; Patients; Pharmacology; Pharmacovigilance; Pharynx; Phenylephrine; Public awareness; Resuscitation; Sepsis; Side effects; Skin diseases; Sulfamethoxazole; Toxic epidermal necrolysis; Trimethoprim
• ISSN: 0114-5916; 1179-1942

Introduction: Toxic epidermal necrolysis (NET) or Lyell's syndrome is a rare, unpredictable, and potentially fatal bullous toxiderma. The disease requires early management in an intensive care unit, at best in a burn resuscitation unit. Objective: To describe the clinical, paraclinical, therapeutic, evolutionary data of patients hospitalized in the burn resuscitation department and establish the imputability of drugs in the occurrence of this adverse event. Methods: Our work is a retrospective descriptive study over a twoyear period from January 2020 to March 2022. All our cases were reported to the National Pharmacovigilance Center of Morocco and were the subject of an evaluation of the causal link between the appearance of Lyell syndrome and the drugs taken by patients according to the French method of study of imputability of adverse drug reactions in its updated version. Results: Out of 500 patients admitted to the service, 05 cases of NET were identified, an incidence of 01%. The notion of drug intake was present in all our patients. The drugs incriminated were Sulfamethoxazole-Trimethoprim, paracetamol, rivaroxaban, a specialty anti-cold combining (Paracetamol + ChlorphenamineMaleate + Salicylamide + Phenylephrine) and amoxicillin + claclolan acid. All patients had erythematous macular and maculopapulous lesions, of varying sizes, spread throughout the body associated with mucous and ophthalmic involvement. The median assessment of burned skin surface was 80%. Two patients progressed to sepsis and broadspectrum antibiotic therapy was started. Patients received early management with exclusive symptomatic treatment, with care for skin and oro-pharyngeal lesions. The evolution was almost favorable for all our patients. Conclusion: NET is a rare pathology that can be fatal. This serious drug complication requires mandatory reporting to pharmacovigilance. Several immunological and viral genetic factors are believed to be involved in the pathophysiological of Lyell Syndrome but which are still poorly elucidated. Raising public awareness of the risks associated with self-medication and of doctors of the risks of drug prescribing remains the best means of prevention.