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This case report describes a 40-year-old woman with a history of endometriosis and recent ulcerative colitis who developed Stevens-Johnson syndrome after twenty days of treatment with sulfasalazine. The lymphocyte transformation test yielded positive results, confirming sulfasalazine as the causative agent for this severe drug reaction. The authors conclude that this in vitro testing method is useful for identifying specific triggers to prevent future complications. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.
Abstract
BACKGROUND: Stevens-Johnson syndrome is a severe drug reaction. Sulfonamides have been associated with drug reactions, complications, sequelae, even death.
CASE REPORT: A 40-year-old female patient with a medical history of endometriosis and recently diagnosed chronic inflammatory ulcerative colitis. She was treated at the Allergology service of the San Juan de Dios Hospital of the Costa Rican Social Security Fund, and after 20 days of treatment with sulfasalazine she had a severe drug reaction on the skin, compatible with Stevens-Johnson syndrome. The lymphocyte transformation test was positive, confirming sulfasalazine as the causative agent.
CONCLUSION: The lymphocyte transformation test is a useful method that can confirm the causative agent and prevent important complications in the future.
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Resumen
Antecedentes: El síndrome de Stevens-Johnson es una reacción medicamentosa severa. Las sulfamidas se han asociado con reacciones medicamentosas, complicaciones, secuelas, incluso la muerte.
Reporte de caso: Paciente femenina de 40 años, con antecedentes médicos de endometriosis y colitis ulcerativa crónica inflamatoria de reciente diagnóstico. Fue atendida en el servicio de Alergología del Hospital San Juan de Dios de la Caja Costarricense del Seguro Social, y luego de 20 días de tratamiento con sulfasalazina tuvo una reacción medicamentosa severa en la piel, compatible con síndrome de Stevens-Johnson. La prueba de transformación linfocitaria resultó positiva, con lo que se confirmó la sulfasalazina como el agente causal.
Conclusiones: La prueba de transformación linfocitaria es un método útil que puede confirmar el agente causal y prevenir complicaciones importantes a futuro.
Palabras clave: Síndrome de Stevens-Johnson; reacción medicamentosa grave; sulfonamidas; sulfasalazina; prueba de transformación linfocitaria.
Referencias
Hernández C.A, Restrepo R, Mejía M. Síndrome de Stevens-Johnson y necrólisis epidérmica tóxica. Rev Asoc Colomb Dermatol. 2011;19: 67-75.
Harr T, French L.E. Toxic epidermal necrolysis and Stevens-Johnson syndrome. Orphanet Journal of Rare Diseases. 2010; 5:39. http://www.ojrd.com/content/5/1/39
Sotelo-Cruz N. Síndrome de Stevens-Johnson y necrólisis epidérmica tóxica en los niños. Gaceta Médica de México. 2012;148:265-275.
Martínez-Pérez J, Caldevilla-Bernardo D, Perales-Pardo R, Pérez-Gómez F. Síndrome de Stevens-Johnson: a propósito de un caso de fiebre y erupción cutánea. Semergen. 2012; 38(4): 245-247.
Frantz R, Huang S, Are A, Motaparthi K. Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Review of Diagnosis and Management. Medicin. 2021; 57: 895. https://doi.org/10.3390/medicina57090895
Martínez-Cabriales S.A, Gómez-Flores M, Ocampo-Candiani J. Actualidades en farmacodermias severas: Síndrome de Stevens-Johnson (SSJ) y Necrólisis epidérmica tóxica (NET). Gac Med Mex. 2015;151: 777-787.
Wetter D.A, Camilleri M.J. Clinical, Etiologic, and Histopathologic Features of Stevens-Johnson Syndrome During an 8-Year Period at Mayo Clinic. Mayo Clin Proc. 2010; 85(2): 131-138. ‘
Barbarroja-Escudero J, Sánchez-González M.J, Antolín-Amérigo D, y Álvarez de Mon Soto M. Indicación e interpretación de las pruebas in vitro de detección etiológica alérgica. Medicine. 2013; 11(29): 1825-1828.
Sachs B, Fatangare A, Sickmann A, Glassner A. Lymphocyte transformation test: History and current approaches. Journal of Immunological Methods. 2021. 493: 113036.
Schneider J.A, Cohen P.R. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Concise Review with a Comprehensive Summary of Therapeutic Interventions Emphasizing Supportive Measures. Adv Ther. 2017; DOI 10.1007/s12325-017-0530-y
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.
Derechos de autor 2023 Revista Alergia México
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MeSH descriptors
Colitis, Ulcerative
Colitis, Ulcerative
Colitis, Ulcerative
Colitis, Ulcerative
Colitis, Ulcerative
Colitis, Ulcerative
Colitis, Ulcerative
Colitis, Ulcerative
Colitis, Ulcerative
Colitis, Ulcerative
Colitis, Ulcerative
Colitis, Ulcerative
Colitis, Ulcerative
Colitis, Ulcerative
Colitis, Ulcerative
Colitis, Ulcerative
Colitis, Ulcerative
Colitis, Ulcerative
Colitis, Ulcerative
Colitis, Ulcerative