sulindac and Stevens-Johnson-Syndrome

Nineteen-year-old woman with mixed connective tissue disease developed Stevens-Johnson syndrome following treatment of arthritis using sulindac. Involvements of infectious and malignant diseases have been ruled out and sulindac has strongly been suspected as a causative agent for Stevens-Johnson syndrome. Ten out of 13 cases with Stevens-Johnson syndrome associated with non-steroidal anti-inflammatory drugs, sulindac has been administrated. Four cases also presented with severe liver disease. Patients who developed Stevens-Johnson syndrome following sulindac administration did not have apparent common clinical or laboratory findings which might be implicated for development of this severe side effects. Among the various non-steroidal anti-inflammatory drugs, safety of sulindac has widely been appreciated. However, occurrence of severe adverse events as reported here indicated that sulindac should be administrated as carefully as other non-steroidal anti-inflammatory drugs.

Topics: Adult; Chemical and Drug Induced Liver Injury; Cholestasis; Female; Humans; Mixed Connective Tissue Disease; Stevens-Johnson Syndrome; Sulindac

Topics: Cross-Cultural Comparison; Drug Industry; Drug Labeling; Drugs, Generic; Humans; Stevens-Johnson Syndrome; Sulindac; Therapeutic Equivalency; United States; United States Food and Drug Administration

All nonsteroidal anti-inflammatory agents may have dermatological side effects, most of them harmless. However, serious adverse dermatological reactions have been described. The article presents a patient with probable sulindac-induced toxic epidermal necrolysis (TEN), and reviews the literature.

Topics: Aged; Female; Humans; Stevens-Johnson Syndrome; Sulindac

A case of sulindac-induced toxic epidermal necrolysis (TEN) is described; the etiology, symptoms, and treatment of TEN are reviewed; and sulindac's pharmacokinetic characteristics and other adverse effects are discussed. A 62-year-old black woman was given a prescription for sulindac 150 mg twice daily to relieve pain associated with degenerative joint disease. She also had a nine-year history of type II diabetes mellitus that was being managed with tolbutamide 500 mg once daily. After two weeks of sulindac therapy she developed a rash that spread over her entire body. Sulindac therapy was discontinued, and one day later the patient was admitted to the hospital with a temperature of 104.6 degrees F, conjunctivitis, and an erythematous macular rash over 60% of her body. Initially, therapy included prednisone 160 mg orally every day, applications of silver sulfadiazine cream four times daily for two days, and methylcellulose 0.5% ophthalmic solution (two drops four times daily) for the conjunctivitis. She also received intravenous hydration. By the fifth hospital day the patient's skin lesions and conjunctivitis had improved to the point that the prednisone dosage was tapered to 120 mg, then to 80 mg, and then to nothing over the following three days. Her diabetes was managed by short-term treatment with NPH insulin; however, before discharge, tolbutamide therapy was reinstituted, and insulin was discontinued. At follow-up four weeks after discharge, the patient's skin was largely clear. TEN has multiple etiologies, but the basic mechanism of injury is believed to be an immunological reaction directed at the basal cell layer.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Female; Humans; Indenes; Middle Aged; Prednisolone; Stevens-Johnson Syndrome; Sulindac

A 37-year-old woman died after 18 days from her starting to take sulindac for low back pain. Based on her clinical course and the autopsy findings, the cause of her death was Lyell syndrome (toxic epidermal necrolysis) induced by sulindac. This case is described together with the legal aspects of medical malpractice to which it gave rise.

Topics: Adult; Female; Humans; Indenes; Malpractice; Mucous Membrane; Skin; Stevens-Johnson Syndrome; Sulindac

Toxic epidermal necrolysis with epidermal shedding over almost the entire body occurred in a patient with classical rheumatoid arthritis treated with sulindac, penicillamine and a combination analgesic containing paracetamol and chlormezanone. Erosions in the lower respiratory tract and the intestine contributed to a lethal outcome of the disease and showed a microscopical picture similar to that of the skin involved. The histopathological picture of these extracutaneous lesions have been only briefly reported previously.

Topics: Acetaminophen; Arthritis, Rheumatoid; Biopsy; Chlormezanone; Drug Combinations; Female; Humans; Intestine, Large; Middle Aged; Penicillamine; Respiratory System; Skin; Stevens-Johnson Syndrome; Sulindac

Topics: Adolescent; Anti-Bacterial Agents; Bandages; Biological Dressings; Female; Humans; Indenes; Prognosis; Stevens-Johnson Syndrome; Sulindac

The nonsteroidal anti-inflammatory drugs are widely used in the United States and are a frequent cause of cutaneous reactions. Since December 1980, dermatologists have reported 135 of these drug reactions to a specialty-based Adverse Drug Reaction Reporting System. Reactions to piroxicam were most frequently reported; the majority of reactions to this drug were vesiculobullous and occurred most often in sun-exposed areas. Other reactions to nonsteroidal anti-inflammatory drugs not previously recognized include serum sickness, exfoliative erythroderma, and photosensitivity associated with sulindac; toxic epidermal necrolysis was reported with tolmetin, zomepirac sodium, and piroxicam. Fixed drug eruptions were noted with ibuprofen and naproxen, and photosensitivity was reported with sulindac and indomethacin. These findings illustrate the usefulness of a specialty-based system for spontaneous reporting of new and serious adverse reactions to drugs.

Topics: Aged; Anaphylaxis; Anti-Inflammatory Agents; Drug Eruptions; Drug Hypersensitivity; Female; Humans; Meclofenamic Acid; Photosensitivity Disorders; Piroxicam; Propionates; Stevens-Johnson Syndrome; Sulindac; Thiazines; Tolmetin

We report 2 patients who had serious adverse effects after taking sulindac. One of these patients developed toxic hepatitis and Stevens-Johnson/toxic epidermal necrolysis syndrome which resulted in death. Such fatal reaction to sulindac therapy has not been reported previously. There was temporal relation of ingestion of sulindac to 2 episodes of acute pancreatitis in the 2nd patient, strongly suggesting drug induction. Recent reports of similar side effects with other nonsteroidal antiinflammatory drugs suggest that these drugs may have potentially more serious toxicity than has been recognized.

Topics: Acute Disease; Arthritis, Rheumatoid; Back Pain; Chemical and Drug Induced Liver Injury; Female; Humans; Indenes; Middle Aged; Pancreatitis; Stevens-Johnson Syndrome; Sulindac

Sulindac is a nonsteroidal anti-inflammatory agent that has been associated with serious adverse reactions. We saw four patients with reactions associated with sulindac. Our patients, one of whom died, had high temperatures and involvement of one or more organs, including the skin, liver, CNS, lymph nodes, bone marrow, and lungs. Eight similar previously reported cases also are summarized. In view of these cases of sulindac-induced toxicity, six of which were proved unequivocally by drug rechallenge, we suggest that physicians be cautious in prescribing this agent.

Topics: Adult; Chemical and Drug Induced Liver Injury; Drug Eruptions; Female; Fever; Humans; Indenes; Male; Middle Aged; Stevens-Johnson Syndrome; Sulindac

Topics: Aged; Female; Humans; Indenes; Skin; Stevens-Johnson Syndrome; Sulindac

Topics: Adult; Female; Humans; Indenes; Shoulder Injuries; Skin; Stevens-Johnson Syndrome; Sulindac