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  • Carbamazepine-induced Stevens-Johnson syndrome/toxic epidermal necrolysis overlap in a Filipino with positive HLA-B75 serotype

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Rare disease
CASE REPORT
Carbamazepine-induced Stevens-Johnson syndrome/toxic epidermal necrolysis overlap in a Filipino with positive HLA-B75 serotype
  1. Francis Capule1,2,
  2. Pramote Tragulpiankit1,
  3. Surakameth Mahasirimongkol3,
  4. Nuanjun Wichukchinda3,
  5. Jiraphun Jittikoon4,
  6. Lara Theresa Alentajan-Aleta5,
  7. Jay-V James Barit6,
  8. Josephine Casanova-Gutierrez7,
  9. Leonor Cabral-Lim7,
  10. Jose Paciano Baltazar Reyes7,
  11. Francisca Roa6,
  12. Katrina Faith San Gabriel5,
  13. Catherine Lynn Silao8,9
  1. 1Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
  2. 2Department of Pharmacy, College of Pharmacy, University of the Philippines Manila, Manila, Philippines
  3. 3Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
  4. 4Department of Biochemistry, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
  5. 5Section of Allergy and Immunology, Department of Medicine, Philippine General Hospital and College of Medicine, University of the Philippines Manila, Manila, Philippines
  6. 6Section of Dermatology, Department of Medicine, Philippine General Hospital and College of Medicine, University of the Philippines Manila, Manila, Philippines
  7. 7Section of Adult Neurology, Department of Neurosciences, Philippine General Hospital and College of Medicine, University of the Philippines Manila, Manila, Philippines
  8. 8Institute of Human Genetics, National Institutes of Health, University of the Philippines Manila, Manila, Philippines
  9. 9Department of Pediatrics, Philippine General Hospital and College of Medicine, University of the Philippines Manila, Manila, Philippines
  1. Correspondence to Francis Capule, frcapule{at}up.edu.ph

Summary

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are two related mucocutaneous disorders with different severities. Although the incidence is low, SJS and TEN are life-threatening and predominantly drug-induced conditions. There is a strong relationship between the HLA-B*1502 allele and carbamazepine-induced SJS and TEN in different Southeast Asian populations. Here, we report a case of Filipino with SJS/TEN overlap probably induced by carbamazepine. The condition was treated with hydrocortisone followed by prednisone. The HLA-B*1502 allele was not found in this case. The patient tested positive for the HLA-B75 serotype, suggesting that carbamazepine-induced SJS/TEN may be serotype specific. Establishing the genotype before initiation of the drug may be advantageous for some patients and will aid physicians in determining the optimal drug therapy. Prevention of adverse drug reactions (ADR) may be done if pharmacists and other healthcare professionals work as a multidisciplinary ADR team to ensure that safe medication practices are realised.

  • pharmacology and therapeutics
  • genetics

https://doi.org/10.1136/bcr-2018-225028

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    Footnotes

    • Contributors All authors contributed equally to drafting, revision, and preparation of the manuscript. All authors read and approved the final version. FC is the principal investigator. He initiated the collaborative research, conceptualised and designed the study with coauthors, monitored all research activities and analysed the data. PT, SM, NW, and JJ provided academic guidance, technical assistance and practical support in all matters concerning research; supervised the genotyping, quality control procedures and proper disposal of unused DNA samples after genotyping; and analysed the data. LTAA, JJB, JCG, LCL, JPBR, FR, and KFSG provided technical assistance in all matters concerning research, most especially in the clinical aspect of the study. They were involved in data collection and analysis, photos and biopsy slide retrieval, patient recruitment, informed consent taking, patient interview, and saliva sample collection. CLS provided technical assistance in all matters concerning research, most especially in the laboratory work of the study. She supervised the DNA extraction protocol optimization, DNA extraction, quality control procedures, and sample storage.

    • Funding This study was funded by National Institutes of Health, University of the Philippines Manila (grant no: NIH 2017-001).

    • Competing interests None declared.

    • Patient consent Parental/guardian consent obtained.

    • Ethics approval This study was approved by the University of the Philippines Manila Research Ethics Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.