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Sulindac-induced toxic epidermal necrolysis
1Medical College of Virginia/VCU, Richmond 23298-0581.
Clinical Pharmacy
|October 1, 1988
Summary
This case report details a 62-year-old woman who developed toxic epidermal necrolysis (TEN) after taking sulindac for joint pain. Prompt treatment led to her recovery, highlighting the importance of recognizing drug-induced severe skin reactions.
Area of Science:
- Dermatology
- Pharmacology
Background:
- Toxic epidermal necrolysis (TEN) is a severe, life-threatening mucocutaneous reaction.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the medications implicated in TEN.
- Sulindac, an NSAID, has been associated with various adverse effects.
Observation:
- A 62-year-old woman developed a widespread rash, fever, and conjunctivitis after two weeks of sulindac therapy for degenerative joint disease.
- The patient's condition rapidly worsened, necessitating hospitalization and intensive treatment.
- Initial management included systemic corticosteroids, topical antimicrobials, and ophthalmic solutions.
Findings:
- The patient's symptoms significantly improved with the discontinuation of sulindac and initiation of supportive care and corticosteroids.
- Prednisone dosage was successfully tapered, and her skin lesions and conjunctivitis resolved.
- Diabetes management was temporarily altered but tolbutamide was reinstituted upon discharge.
Implications:
- This case underscores the potential for sulindac to induce severe cutaneous adverse reactions like TEN.
- Early recognition and withdrawal of the offending agent are critical for managing TEN.
- Understanding sulindac's pharmacokinetic profile is essential for predicting and mitigating adverse events.