engleski

Fatal toxic epidermal necrolysis secondary to carvedilol

Beta-adrenoreceptor blocking drugs are widely used throughout the world, and serious adverse reactions are relatively uncommon. Toxic epidermal necrolysis (TEN) is a rare, severe adverse reaction characterized by a low incidence but high mortality. The exact pathogenesis of TEN and Steven-Johnson syndrome, the milder end of the spectrum, is unknown. We report a case of TEN developed in a 70-year old woman that was started on carvedilol due to hypertension 3 days prior the rash occurrence. The patient had a history of Mb. Hodgkin in remission, previously treated with chemotherapy and irradiation, hypertension and hypothyreosis.On the third day of carvedilol therapy the patient experienced generalized pruritus but has continued the prescribed treatment. During the next 2-3 days she developed a rash characterized by red maculae with central blistering and the shape of scattered 2-ring target-like lesions with a dark red centre and lighter red halo, fever and conjunctivitis. Diagnosis of SJS was suggested, therapy with carvedilol was withdrawn and systemic corticosteroid and supportive therapy initiated. Over the next 24 hours a separation of large sheets of epidermis from the dermis developed, involving more than 30% of total body skin surface consistent with TEN. Almost total epidermal loss resulted within 48 h. The mucosal surfaces of mouth and genital areas were also involved. Conclusions: Although adverse skin reactions to beta-blockers occur rarely, awareness of the possible unfavorable, even fatal drug reaction is necessary, especially when given to patients previously treated for malignant disease.

carvedilol; drug hypersensitivity; toxic epidermal necrolysis

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