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Levamisole induced toxic epidermal necrolysis: A case report
Rachna Rohilla1, Arihant Jain2
1Department of Pharmacology, Postgraduate Institute of Medical Education and Research, DM-Resident Clinical Pharmacology, Chandigarh, India.
British Journal of Clinical Pharmacology
|August 28, 2020
Summary
Levamisole, an antihelminthic, may trigger toxic epidermal necrolysis (TEN), a severe skin reaction. This case highlights the need for clinicians to consider levamisole as a potential cause of Stevens-Johnson syndrome/TEN.
Area of Science:
- Dermatology
- Immunology
- Pharmacology
Background:
- Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe, life-threatening immune reactions.
- Numerous drugs, including NSAIDs, allopurinol, anticonvulsants, and antibiotics, are known triggers for SJS/TEN.
- Levamisole, used as an antihelminthic and immunomodulator, has not been previously linked to SJS/TEN.
Observation:
- A 15-year-old male presented with symptoms of TEN, including widespread skin lesions, blistering, and epidermal detachment.
- The patient's condition involved up to 30% of his body surface area.
- Causality assessment using the drug causality for epidermal necrolysis score indicated a 'possible' relationship between levamisole and the observed TEN.
Findings:
- This case report details the first documented instance of levamisole-induced TEN.
- Prompt discontinuation of levamisole, coupled with corticosteroids and cyclosporine, resulted in clinical improvement.
- The drug causality for epidermal necrolysis scoring supported a potential link between levamisole and the adverse event.
Implications:
- Clinicians must be aware of the potential for levamisole to induce SJS/TEN.
- This finding expands the list of potential drug triggers for severe cutaneous adverse reactions.
- Further research may be warranted to elucidate the immunopathogenesis of levamisole-induced SJS/TEN.
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