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Life-Threatening Drug-Induced Rashes
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Life-Threatening Drug-Induced Rashes
, Acute Life-threatening Hypersensitivity Skin Reaction
See Also
Adverse Drug Reaction
Hypersensitivity Reaction
Anaphylaxis
Penicillin Allergy
Gell and Coombs Classification
Fixed Drug Eruption
Causes
ABCDS Mnemonic
See
Anaphylaxis
Acute Generalized Exanthematous Pustulosis
(
AGEP
)
Non-follicular
Pustular lesion
s at the flexor surfaces
Within 4 days of beta lactam,
Macrolide
or
Calcium Channel Blocker
exposure
Associated fever,
Leukocytosis
and
Neutrophilia
Drug-Induced Bullous Disease
Bulla
e insidious onset with
ACE Inhibitor
s, beta-lactam antibiotics,
Calcium Channel Blocker
s,
Furosemide
,
Vancomycin
Captopril
or ACE-Inhibitor induced
Angioedema
Drug Reaction with Eosinophilia and Systemic Symptoms
(
DRESS Syndrome
)
Presentation similar to
Fixed Drug Eruption
(
Morbilli
form rash) presentation, but >2 weeks after exposure
Anticonvulsants (esp.
Dilantin
) are most common causes, but also occurs with
Sulfonamide
s and
Allopurinol
Associated with fever,
Lymphadenopathy
, nephritis, transaminitis,
Eosinophilia
,
Myositis
,
Encephalitis
Mortality approaches 10% due to fulminant liver failure
Stevens-Johnson Syndrome
(10% BSA) or
Toxic Epidermal Necrolysis
(30% BSA)
Onset 7-21 days after exposure to
Sulfonamide
s, anticonvulsants,
NSAID
s,
Allopurinol
Macule
s, target lesions and erosions with skin sloughing and mucous membrane involvement
References
Jhun and DeClerck in Herbert (2015) EM:Rap 15(2): 9-11
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