Ibuprofen – induced toxic epidermal necrolysis – A CASE REPORT

Indira Melezović, Samir Mehmedagić, Edin Begić, Mevludin Mekić, Emela Čvorak

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe, life-threatening mucocutaneous hypersensitivity reactions. The inflammatory response is mediated by cytotoxic T lymphocytes and NK (natural killer) cells with cytotoxic proteins and cytokines as mediators in the onset of cell apoptosis. Drugs are responsible for about 95% of cases of toxic epidermal necrolysis. Although non-steroidal anti-inflammatory drugs (NSAID) are classified as drugs that can potentially lead to this hypersensitivity reaction, a small number of cases have been described in the literature regarding the occurrence of this reaction to the use of ibuprofen. We present the case of a 58-year-old man who developed symptoms of TEN seven days after using ibuprofen. The treatment of toxic epidermal necrolysis is still a matter of debate. Given that there is no uniform protocol for treatment, and the lethal outcome in such conditions occurs in about 40% of cases, each presented case is significant in terms of considering the effectiveness and improvement of the therapeutic approach.

Stevens-Johnsonov sindrom (SJS) i toksična epidermalna nekroliza (TEN) teške su, po život opasne, mukokutane reakcije preosjetljivosti. Inflamatorni odgovor je posredovanom citotoksičnim T-limfocitima i NK (engl. natural killer) stanicama uz citotksične proteine i citokine kao posrednike u nastanku stanične apoptoze. Lijekovi su odgovorni za oko 95% slučajeva toksične epidermalne nekrolize. Iako se nesteroidni protuupalni lijekovi (NSAIL) svrstavaju u lijekove koji potencijalno mogu dovesti do ove reakcije preosjetljivosti, u literaturi je opisan mali broj slučajeva u vezi s nastankom ove reakcije na primjenu ibuprofena. Prezentiramo slučaj 58-godišnjeg muškarca kojemu su se simptomi TEN-a pojavili sedam dana nakon početka primjene ibuprofena. Tretman toksične epidermalne nekrolize i dalje je predmetom rasprava. Budući da ne postoji jedinstven stav i protokol za liječenje, a letalni ishod u ovakvim se stanjima događa u do 40% slučajeva, svaki je prezentirani slučaj značajan u pogledu razmatranja učinkovitosti i poboljšanja terapijskog pristupa.