One case of bullous epidermal necrolysis type drug eruption induced by paracetamol and codeine tablets (I) and ibuprofen sustained-release capsules

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Author: Yan-Ju LI ¹  Jie-Mei FAN ¹ Fang WANG ² Shuai LEI ³  Xin-Suo DUAN ⁴ Xiang LI ¹

Affiliation: 1. Chengde ADR Monitoring Center, Chengde 067000, Hebei Province, China 2. Drug Alert Center of Hebei Province, Shijiazhuang 050000, China 3. Department of Pharmacy, Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei Province, China 4. Department of Dermatology and Venereal Diseases, Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei Province, China

Keywords: Paracetamol and codeine tablets (I) Ibuprofen sustained-release capsules Bullous epidermal necrolysis type drug eruption Adverse drug reactions

DOI: 10.19960/j.issn.1005-0698.202305014

Reference: Yan-Ju LI, Jie-Mei FAN, Fang WANG, Shuai LEI, Xin-Suo DUAN, Xiang LI.One case of bullous epidermal necrolysis type drug eruption induced by paracetamol and codeine tablets (I) and ibuprofen sustained-release capsules[J].Yaowu Liuxingbingxue Zazhi,2023, 32(5): 590-595.DOI: 10.19960/j.issn.1005-0698.202305014.[Article in Chinese]  Copied

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Abstract

A 77-year-old male patient with herpes zoster pain in left lower limb developed toxic epidermal necrolysis after treated with paracetamol and codeine tablets (I), 1 tablet per day, for 20 days and ibuprofen sus-tained-release capsules 0.3 g. After medication, dark purple erythema and blisters appeared on the trunk and limbs, accompanied by pain. After 3 days, the area of erythema became larger, the number of blisters increased, and part of them fused into bullae. Nielsen's sign was positive, and tenderness was positive; the oral mucosa was diffusely flushed without erosion, the skin lesions gradually aggravated and spread all over the body. He was diagnosed with bullous epidermal necrolysis type drug eruption and hospitalized. He had lip and oral mucosa erosion on the second day after hospitalization. After discontinuing the suspected drugs of paracetamol and codeine tablets (I) and ibuprofen, the patient was given antihistamine and anti-allergic treatment: methylprednisolone sodium succinate for injection 60 mg·d^-1 intravenously, desloratadine tablets 8.8 mg·d^-1 orally, cetirizine hydrochloride tablets 10 mg·d^-1 orally, fluticasone propionate cream appropriate for external use, compound phellodendron amurense solution appropriate for external use to prevent infection, calcium carbonate to prevent osteoporosis, omeprazole enteric-coated capsules to inhibit acid and protect stomach, and other treatments. On the 6th day, most of the patients' lip scabs fell off, the ero-sion surface of oral mucosa was basically healed, the blisters on the trunk and limbs were dry and scabbed, and there was no new rash. The drug eruption was significantly improved. On the 7th day, the patients recovered and dis-charged from the hospital. It is considered that the occurrence of bullous epidermal necrolysis drug eruption is related to the drug allergy caused by the use of paracetamol and codeine tablets (I) and ibuprofen.

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