Systemic lupus erythematosus patient on steroid therapy that develop to a Stevens-Johnson syndrome: a case report

Authors

  • Ketut Suardamana Allergy and Immunology Division, Universitas Udayana, Sanglah General Hospital, Bali, Indonesia
  • Pande Ketut Kurniari Rheumatology Division, Universitas Udayana, Sanglah General Hospital, Bali, Indonesia
  • I. Made Arya Winangun Internal Medicine Department, Universitas Udayana, Sanglah General Hospital, Bali, Indonesia

DOI:

https://doi.org/10.18203/2349-3933.ijam20221363

Keywords:

SJS, SLE, Steroid

Abstract

Stevens-Johnson syndrome (SJS) is a cutaneous immunity reaction involving the skin and mucosa and is an emergency condition that can be fatal. The incidence of this disease is relatively rare in the range of 1-2 per 1.000.000 population. The pathogenesis of SJS involves the immune system response of antigenic drug to body tissues but it still cannot be fully explained to date. We reported a woman, 35 years old with systemic lupus erythematosus (SLE) who had been on steroid therapy and in the course of treatment developed into SJS after administration of anti-epileptic drug. Steroids have anti-inflammatory effects mainly due to decreased syntheses or suppression of inflammatory mediators. SJS still can develop in patient with SLE who had been on steroid therapy. Giving steroid that indicated for the treatment of a disease including SLE, cannot prevent the occurrence of an allergic event including SJS. The presence of steroid can extend the duration of starting the drug with the occurrence of SJS and reduce the severity of the disease. Steroid still have a role in treatment that can be used both in SJS and SLE.

References

Harr T, French LE. Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome. Orphanet J Rare Dis. 2010;39(5):1-11.

Lee HY, Martanto W, Thirumoorthy T. Epidemiology of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Southeast Asia. Dermatologica Sinica. 2013;31:217-20.

Abe R. Immunological Response in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. J Dermatol. 2014;41:1-7.

Eginli A, Shah K, Watkins C, Krishnaswamy G. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Ann Allergy Asthma Immunol. 2017;118:143-7.

Stern RS, Divito SJ. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Associations, Outcomes, and Pathobiology-Thirty Years of Progress but Still Much to Be Done. J Invest Dermatol. 2017;137:1004-8.

Borrelli EP, Lee EY, Descoteaux AM, Kogut SJ, Caffrey AR. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis with Antiepileptic Drugs: An Analysis of the US Food and Drug Administration Adverse Event Reporting System. Epilepsia. 2018:1-7.

Perhimpunan Reumotalogi Indonesia. Rekomendasi Perhimpunan Reumatologi Indonesia: Diagnosis dan Pengelolaan Lupus Eritematosus Sistemik. Jakarta: Perhimpunan Reumatologi Indonesia. 2019l1-41.

Pusdatin. Situasi Lupus di Indonesia. Pusat Data dan Informasi Kementerian Kesehatan RI, 2017. Available at: http://www.depkes.go.id/ /pusdatin/infodatin/Infodatin-Lupus-2017.pdf. Accessed on 09 October 2019.

Becker DE. Basic and Clinical Pharmacology of Glucocorticosteroids. Anesthesia Progress. 2013;60(1):25-32.

Perhimpunan Dokter Spesialis Kulit dan Kelamin Indonesia. Nekrolisis Epidermal (SSJ dan NET) dalam Panduan Praktik Klinis bagi Dokter Spesialis Kulit dan Kelamin di Indonesia. Jakarta: PERDOSKI. 2017;398-402.

Suarjana IN. Imunopatogenesis Lupus Eritematosus Sistemik in Buku Ajar Ilmu Penyakit Dalam Jilid III. 6th ed. Setiati S, eds. Jakarta: InternaPublishing; 2015: 3333-3345.

Oppong E, Cato ACB. Effects of Glucocorticoids in the Immune System in Glucocorticoid Signaling: from Molecules to Mice to Man (Advances in Experimental Medicine and Biology): Wang JC, Harris C (editors). New York: Springer. 2015;217-33.

Schrijvers R, Gilissen L, Chiriac AM, Demoly P. Pathogenesis and Diagnosis of Delayed‑Type Drug Hypersensitivity Reactions, from Bedside to Bench and Back. Clin Translational Allergy. 2015;31(5):1-10.

Liberman AC, Budzinski ML, Sokn C, Gobbini RP, Steininger A, Arzt E. Regulatory and Mechanistic Actions of Glucocorticoids on T and Inflammatoy Cells. Frontiers in Endocrinol. 2018;236(9):1-14.

Cahyadi A, Anindita K, Iryaningrum MR. Stevens-Johnson Syndrome in a Patient with Systemic Lupus Erythematosus on Tuberculostatic Treatment. Med J Indonesia. 2012;21:235-9.

Zimmermann S, Sekula P, Venhoff M, Motschall E, Knaus J, Schumacher M et al. Systemic Immunomodulating Therapies for Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Systematic Review and Meta-Analysis. JAMA Dermatol. 2017:1-9.

Downloads

Published

2022-05-24

Issue

Section

Case Reports