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Lansoprasole as fatal cause of toxic epidermal necrolysis.

Proton pump inhibitors (PPIs) are commonly used in clinical practice of peptic ulcer disease and gasto-esophageal reflux and are well tolerated by the patients. Stevens-Johnson syndrome/Toxic epidermal necrolysis (TEN/SJS) are severe adverse drug reactions with low incidence and high mortality rates (20-30%) characterized with severe and extensive skin detachment. TEN/SJS are characterized with keratinocyte apoptosis and separation of epidermis and dermis. Proton pump inhibitors in 20% are associated with hypersensitivity and anaphylactic reaction. 881 reports of skin reactions to lansoprasole has been reported. Material and Methods: We report a clinical course of fatal outcome of patients with TEN due to Lansoprazole. Female patient aged 75 yrs was admitted to our Department due to severe drug reaction which started 6 days prior to the hospitalization. Patient had arterial hypertension, diabetes mellitus type II, anaemia and hyperlipidemia and has been prescribed new medication 2 weeks prior to hospitalization: Lansoprazole, Hydrochlorothiazide in combination with Ramipril and Amlodipine. She was taking Cordipine before this hospitalization. Pruritus occured 2 days after the introduction of new medications and shortly after was followed by diffuse urticarial exanthema with joint swelling. Results: All medications were stopped immediately and peroral corticosteroids and antihistamines were introduced but skin changes progressed despite of the therapy. On the first day diffuse confluent urticarial and macular exanthema was observed, and was partially confluent forming wide erythematous region, with large flaccid bullas especially in axillas, inguinum, genitalia and back. Wide regions of erosions were found on the back, abdomen and extremities. Atypical iris-like lesions were found on hands. Genital region and oral mucosa were also affected. Skin changes progressed into erythrodermia during the few next days, followed by diffuse skin shedding. Only face was partially spared. Laboratory findings showed neutropenia, accompanied by renal and hepatic impairment. Skin smear was performed and Staphylococcus aureus was found. Antibiotics with broad spectrum of activity were introduced. Due to severe skin exfoliation at the 5th day of hospitalization (approximately 80% of the skin surface was affected) patient was urgently transferred to Intensive Care unit and died in few next days due to progression of sepsis and multiorgan failure. Conclusions: TEN has high mortality rate, severity of the disease depends on affected skin surface: the more the skin is affected, the more severe prognosis is. Treatment is primarily symptomatic, but regarding the fact that some patients are in a life-threatening situation, the therapy must start immediately with urgent hospital admitting and including all necessary life-support measures. All drugs must be cessated immediately.

Texic epidermal necrolysis; Lansoprasole Stevens-Johnson syndrome

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