Dermatosis Mengancam Jiwa: Sindrom Stevens-Johnson Diduga Akibat Methampyron

Authors

  • Angel Benny Wisan SMF Ilmu Kesehatan Kulit dan Kelamin, RSUD Bali Mandara, Denpasar, Bali, Indonesia
  • Felicia Aviana Fakultas Kedokteran, Universitas Hang Tuah, Surabaya, Jawa Timur, Indonesia

DOI:

https://doi.org/10.55175/cdk.v49i8.272

Keywords:

Dermatosis, methampyron, nekrolisis epidermal, sindrom Stevens-Johnson

Abstract

Sindrom Stevens-Johnson (SSJ) merupakan salah satu dermatosis yang mengancam jiwa dan merupakan bagian dari nekrolisis epidermal (NE), ditandai dengan reaksi mukokutan akut disertai nekrosis luas dan pengelupasan epidermis serta epitel mukosa. Kasus. Laki-laki usia 20 tahun dengan keluhan timbul ruam-ruam kemerahan sejak 2 hari di wajah, menyebar ke leher, dada, perut, punggung, kedua tangan, dan skrotum; diikuti bibir bengkak dan gelembung yang pecah meninggalkan bekas kehitaman. Diduga keluhan muncul setelah pasien mengonsumsi methampyron. Pasien memiliki riwayat systemic lupus erythematosus (SLE) terkontrol. Status dermatologi didapatkan purpura disertai bula dinding kendur pada regio coli, thorax, manus dekstra dan sinistra, dan abdomen. Tanda Nikolsky (+). Pada regio skrotum terdapat bula dinding kendur multipel dan sebagian erosi. Di regio labialis terdapat krusta merah kehitaman multipel, tebal, sulit dilepas, batas irreguler, dan sebagian erosi. Pasien didiagnosis sindrom Stevens-Johnson (SSJ) dan mendapat terapi cairan, methylprednisolone, paracetamol, gentamycin, curcuma, cetirizine, triamcinolone acetonide, desoximetasone, dan chloramphenicol. Pada hari ke-10 perawatan, pasien mengalami perbaikan klinis dan diperbolehkan pulang.

Stevens-Johnson syndrome (SJS) is one of the life-threatening dermatoses and a part of epidermal necrolysis (NE), characterized by mucocutaneous reaction, and followed by an extensive necrosis and detachment of epidermis and mucosal epithelium. A 20 year-old man complained of reddish rashes on the face since 2 days ago. The rashes widened and spread to the neck, body, stomach, back, both hands, and scrotum, followed by swollen lips and broken blisters that leave a blackish scar a day later. The symptoms were suspected to develop after taking methampyrone. The patient had a history of controlled Systemic Lupus Erythematosus (SLE). Dermatology status showed purpura and flaccid blisters on the neck, body, back, both hands, and abdomen, Nikolsky sign (+). Multiple flaccid blisters and partial erosion in the scrotum. On the lips, there are multiple reddish-black crusts, thick, hard to remove, irregular border, and partial erosion. The patient was diagnosed with Stevens-Johnson syndrome (SJS) and given fluid therapy, methylprednisolone, paracetamol, gentamicin, curcuma, cetirizine, triamcinolone acetonide, desoximetasone, and chloramphenicol. On the 10th day of the treatment, the patient was clinically improved and was discharged.

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References

Mockenhaupt M, Roujeau JC. Epidermal necrolysis (Stevens-Johnson syndrome and toxic epidermal necrolysis). In: Kang S, Amagai M, Bruckner Al, Enk AH, Margois DJ, McMichael AJ, Orringer, editors. Fitzpatrick’s dermatology in general medicine. 9th Ed. New York: McGraw-Hill; 2019 .p. 459

Yang SC, Hu S, Zhang SZ, Huang JW, Zhang J, Ji C, et al. The epidemiology of Stevens-Johnson syndrome and toxic epidermal necrolysis in China. J Immunol Res. 2018;2018:4320195. doi: 10.1155/2018/4320195.

Harris V, Jackson C, Cooper A. Review of toxic epidermal necrolysis. Internat J Molecular Sci. 2016;17(12):2135.

Putri ND, Mutiara H, Sibero HT. Stevens-Johnson syndrome et causa paracetamol. Medical Prof J Lampung Univ. 2016;6(1):101-7.

Sateesh Kumar Reddy K, Shanmuga Kumar SD, Vijay Raghavendra NC, Sudheer Kumar K. A case report on diclofenac-induced Stevens Johnson syndrome. J Basic Clin Pharm [Internet]. 2018;9(2). Available from: https://www.jbclinpharm.org/articles/a-case-report-on-diclofenac-induced-stevens-johnson-syndrome-4590.html

Velasco-Tirado V, Alonso-Sardón M, Cosano-Quero A, Romero-Alegría Á, Sánchez-los Arcos L, López-Bernus A, et al. Life-threatening dermatoses: Stevens-Johnson syndrome and toxic epidermal necrolysis. Impact on the Spanish public health system (2010-2015). PLOS One 2018;13(6):e0198582.

Basak AK, Debnath J. Stevens-Johnson syndrome. KYAMC J. 2018;8(2):31-5

Witarini KA. Diagnosis dan tatalaksana sindroma Steven-Johnson (SJS) pada anak: Tinjauan pustaka. Intisari Sains Medis [Internet]. 2019;10(3):592-6. Available from: https://isainsmedis.id/index.php/ism/article/viewFile/588/372

Mukherjee S, Saha D, Dasgupta S, Tripathi SK. Case report: Suspected case of Stevens–Johnson syndrome and toxic epidermal necrolysis overlap due to ursodeoxycholic acid. EMJ Dermatol. 2020;8[1]:96-9.

Effendi EH. Sindrom Stevens-Johnson dan nekrolisis epidermal toksik. In: Menaldi SLSW, editor. Ilmu penyakit kulit dan kelamin. 7th Ed. Jakarta: FK UI; 2017 .p. 199-200.

Kötter T, da Costa BR, Fässler M, Blozik E, Linde K, Jüni P, et al. Metamizole-associated adverse events: A systematic review and meta-analysis. PloS One 2015;10(4):e0122918.

Santosa, Rumbiana A, Wahab Z, Kurniawan SP, Naibaho RM, Yogyartono P. Succesful treatment of methampyrone-induced toxic epidermal necrolysis with therapeutic plasma exchange. Case Rep Med. 2018;2018:2182604.

Deore SS, Dandekar RC, Mahajan AM, Shiledar VV. Drug-induced Stevens-Johnson syndrome: A case report. Int J Sci Stud. 2014;2(4):84-7.

Tan SK, Tay YK. Profile and pattern of Stevens-Johnson syndrome and toxic epidermal necrolysis in a general hospital in Singapore: treatment outcomes. Acta Dermato-Venereol. 2012;92(1):62-6.

El-Azhary RA, Nowsheen S, Gibson LE, DiCaudo DJ. Disseminated intravascular coagulopathy: A complication of Stevens–Johnson syndrome/toxic epidermal necrolysis. Internat J Dermatol. 2021;60(2):185-9.

Williams DM. Clinical pharmacology of corticosteroids. Respiratory Care 2018;63(6):655-70.

McPherson T, Exton LS, Biswas S, Creamer D, Dziewulski P, Newell L, et al. British Association of Dermatologists’ guidelines for the management of Stevens–Johnson syndrome/toxic epidermal necrolysis in children and young people, 2018. Br J Dermatol. 2019;181(1):37-54.

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Published

01-08-2022

How to Cite

Wisan, A. B., & Aviana, F. (2022). Dermatosis Mengancam Jiwa: Sindrom Stevens-Johnson Diduga Akibat Methampyron. Cermin Dunia Kedokteran, 49(8), 443–446. https://doi.org/10.55175/cdk.v49i8.272