Pediatric emergency medicine trisk 1318 1318
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FIGURE 68.11 Hemorrhagic crust and erosions on the lip after desquamation. (Reprinted with
permission from Onofrey BE, Skorin L, Holdeman NR. Ocular Therapeutics Handbook .
Philadelphia, PA: Lippincott Williams & Wilkins; 2011.)
Drugs are the most common trigger for SJS/TEN. Antibiotics (trimethoprimsulfamethoxazole, minocycline), antiepileptics (carbamazepine, phenytoin,
phenobarbital, lamotrigine), NSAIDs, and nevirapine are frequent triggers for
SJS/TEN. The first signs of SJS/TEN can present approximately 7 to 21 days
after starting the medication. Similar to DHR, a genetic predisposition for
SJS/TEN development may be present. Since the identification of the association
between HLA-B*1502 and carbamazepine-induced SJS/TEN in patients of East
Asian descent, the Food and Drug Administration recommends HLA-B*1502
testing prior to carbamazepine initiation. Similarly, HLA-B*5801 has been
associated with allopurinol hypersensitivity and HLA-B*5701 has been
associated with abacavir hypersensitivity.
A mucosal predominant form of SJS associated with mycoplasma infection
was recently renamed Mycoplasma pneumoniae– induced rash and mucositis
(MIRM). Mucositis is a prominent feature of MRIM, though the cutaneous
involvement is absent or minimal. As a result, the clinical course of MRIM is
milder than SJS/TEN. MIRM-like reactions have also been reported with
influenza and Chlamydia pneumoniae infection. Early MRIM may be difficult to
