SJÖGREN-LIKE SYNDROME AFTER DRUG-INDUCED TOXIC EPIDERMAL NECROLYSIS

doi:10.1016/S0140-6736(85)92146-4

The Lancet

Volume 325, Issue 8429, 16 March 1985, Pages 609-611

https://doi.org/10.1016/S0140-6736(85)92146-4 Get rights and content

Abstract

7 of 9 patients recovering from a drug-induced toxic epidermal necrolysis (TEN) which they had had 2 months to 4 years before had xerostomia, or keratoconjunctivitis sicca, or both. 5 patients had symptoms; 2 had severe visual impairment. In 5 cases there was lymphocytic infiltration of small salivary glands; in 2 patients this was identical to that of Sjögren syndrome. None of the patients had antinuclear antibody. TEN may occur during acute graft-versus-host disease (GVHD) and these observations are reminiscent of the sicca syndromes reported during chronic GVHD. They suggest that autoimmune mechanisms may be involved in drug-induced TEN and that Sjögren syndrome may occur as the result of a drug reaction.

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Cited by (74)

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The authors noted that approximately 40% of patients recovering from TEN develop sicca syndrome. All these patients exclusively received supportive care, and none of them received systemic steroids, which might have been a consequence of the natural course of TEN.14 The development of post-TEN “SS-like syndrome” may suggest the involvement of autoimmune phenomena in the process of TEN.
Systemic autoimmune diseases are reportedly associated with a high frequency of drug allergies. In particular, systemic lupus erythematosus (SLE), Sjögren's syndrome (SS), and adult-onset Still's disease (AOSD) have recently drawn attention. Based on previous reports, drug allergies have been reported in 17.1–63%, 7–40.1%, and 17.6–54% of patients with SS, SLE, and AOSD patients, respectively. Antimicrobial agents, including sulfa drugs and nonsteroidal anti-inflammatory drugs, are the most common causative agents of drug allergies. However, few studies have examined in detail the relationship between drug eruptions, a major symptom of drug allergy, and systemic autoimmune diseases, and their actual status remains unclear. These autoimmune diseases commonly exhibit a diverse range of skin manifestations in the course of these diseases, rendering it may be difficult to determine whether it is a true drug eruption.
Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), a fatal, severe drug eruption, has also been associated with autoimmune diseases. The development of SS-like symptoms after SJS/TEN onset and high prevalence of anti–SS–A antibodies in SJS/TEN are intriguing observations. Although the presence of SLE is known to be a risk factor for SJS/TEN, common pathological conditions, such as excessive immune status, abnormal function of regulatory T cells, and neutrophil extracellular traps in autoimmune diseases such as SS and SLE, are potentially involved in the development of drug eruptions.
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Patients with autologous transplantation of SMG for treatment of severe dry eye between March 1998 and May 2018 were divided into the SJS group (70 cases) and non-SJS group (50 cases) according to the history of SJS. The SMG weight and computed tomography volume and salivary flow rate were measured. The concentration index and secretion index were estimated using scintigraphy with technetium-99m-pertechnetate. Histopathology studies of SMG tissues were conducted, and the acini parameters were measured using a digital image analyzer.
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This book is intended as a guide to help the clinician determine where a visual problem is a drug-induced ocular side effect. We continually review spontaneous case reports from the National Registry of Drug-Induced Ocular Side Effects, the World Health Organization, the US Food and Drug Administration, and the world literature. We have attempted to classify a suspected adverse event with our impression to causality (i.e. certain, probable, unlikely, conditional/unclassified). This chapter discusses analgesics, narcotic antagonists, and drugs used to treat arthritis including drugs used to treat gout, antirheumatic drugs, mild analgesics, narcotic antagonists, and strong analgesics.
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SJÖGREN-LIKE SYNDROME AFTER DRUG-INDUCED TOXIC EPIDERMAL NECROLYSIS

Abstract

Dermatol Clin

Lancet

Am J Med

J Invest Dermatol

Toxic epidermal necrolysis (the scalded skin syndrome). A reappraisal

Br J Dermatol

Immune complexes, complement and immunofluorescence in Lyell syndrome

Toxic epidermal necrolysis and homologous disease in hamster

Arch Dermatol

Cutaneous manifestations of graft versus host disease

Int J Dermatol

Sjögren type syndrome after allogeneic bone marrow transplantation

Ann Intern Med