Oral Complications Due to Medication in Stevens-Johnson Syndrome Patient with Systemic Involvement

Authors

  • Rahmi Harmiyati Oral Medicine Departement, Faculty of Dentistry Padjdjaran University, Bandung
  • Fika Faradillah Drakel Oral Medicine Departement, Faculty of Dentistry Padjdjaran University, Bandung
  • Riani Setiadhi Oral Medicine Departement, Faculty of Dentistry Padjdjaran University, Bandung

DOI:

https://doi.org/10.30649/denta.v18i2.6

Keywords:

Diabetes Mellitus, Oral Lesions, Stevens-Johnson Syndrome

Abstract

Background: Stevens-Johnson Syndrome (SJS) is a drug-induced hypersensitivity reaction involving mucocutaneous with various trigger factors including drugs and herpes simplex virus. Objective: This case report aimed to discuss oral complications due to medication in SJS patients with systemic disease involvement. Case: A 51-year-old man was referred to the Department of Oral Medicine, Faculty of Dentistry, Padjadjaran University, at Hasan Sadikin Hospital from the dermatology and venereology department complaining of pain in the oral cavity, especially when eating and drinking two months before, with a history of phenytoin, salbutamol and theophylline therapy. Extraoral examination showed erosive lesions and tended to bleed serosanguinolenta crusts on the lips. Intraoral there were erosive lesions and white plaque on the tongue, buccal mucosa, labial mucosa, and palate, as well as dental caries and calculus. Blood examination showed low hemoglobin, hematocrit, erythrocytes, lymphocytes, monocytes, SGOT, and sodium levels, while HbA1c, random, fasting, and 2 HPP glucose levels were high. Reactive Anti-HSV-1 IgG and rheumatoid factor. KOH examination showed positive spores, hyphae, pseudohypha, and budding cells. The diagnosis was SJS-associated oral lesions with HSV-1 virus infection, oral candidiasis accompanied with diabetes mellitus. For diabetes mellitus treatment, he was referred to the internal medicine department. Case Management: The therapy was 0.9% NaCl for lip compress, acyclovir tablet, nystatin oral suspension, chlorhexidine digluconate 0,12% mouthwash, folic acid, and vitamin B12. Oral lesions were improved significantly after diabetes mellitus was treated. Conclusion: The SJS patient was susceptible to complications in the oral cavity, especially fungal and viral infections due to the received medication.

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References

Flores S, Maglic D, Moores N, Hosein R, Siddiqi F, Gociman B. Successful reconstruction of bilateral oral commissure fusion secondary to Stevens Johnson syndrome. Plast Aesthet Res. 2018;5(7):24.

Chaby G, Lebrun-Vignes B, Haddad C, Hemery F, Ingen-Housz-Oro S, de Prost N, et al. Drug-induced Stevens-Johnson syndrome and toxic epidermal necrolysis: Proportion and determinants of underreporting to pharmacovigilance. Journal of Allergy and Clinical Immunology: In Practice. 2019;7(4):1344–6.

Indrastiti R, Novitasari A, Arum C. Predictor Factors of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. J Kedokteran Muhammadiyah. 2016;5(1):1–6.

Patel TK, Barvaliya MJ, Sharma D, Tripathi C. A systematic review of the drug-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in Indian population. Indian J Dermatol Venereol Leprol. 2013;79(3):389–98.

Avinash A, Mohanbabu Amberkar V, Kunder SK, Madhyastha S, Meena kumari K. Carbamazepine-induced life-threatening Stevens-Johnson Syndrome and Agranulocytosis: The maiden case. Journal of Clinical and Diagnostic Research. 2016;10(12):FD01–3.

Chantaphakul H, Sanon T, Klaewsongkram J. Clinical characteristics and treatment outcome of Stevens-Johnson syndrome and toxic epidermal necrolysis. Exp Ther Med. 2015;10(2):519–24.

Kumar R, Das A, Das S. Management of Stevens-Johnson Syndrome-Toxic Epidermal Necrolysis: Looking Beyond Guidelines! Indian J Dermatol Venereol Leprol. 2018;63(2):117–24.

Creamer D, Walsh SA, Dziewulski P, Exton LS, Lee HY, Dart JKG, et al. UK guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults 2016. Journal of Plastic, Reconstructive and Aesthetic Surgery. 2016;69(6):e119–53.

Ubukata N, Nakatani E, Hashizume H, Sasaki H, Miyachi Y. Risk factors and drugs that trigger the onset of Stevens–Johnson syndrome and toxic epidermal necrolysis: A population-based cohort study using the Shizuoka Kokuho database. JAAD Int. 2023 Jun 1;11:24–32.

Rodrigues C, Rodrigues M, Henriques M. Candida sp. Infections in Patients with Diabetes Mellitus. J Clin Med. 2019;8(1):76.

Mauri-Obradors E, Estrugo-Devesa A, Jané-Salas E, Viñas M, López-López J. Oral manifestations of diabetes mellitus. A systematic review. Med Oral Patol Oral Cir Bucal. 2017;22(5):e586–94.

Yang SC, Lai YY, Huang MC, Tsai CS, Wang JL. Corticosteroid dose and the risk of opportunistic infection in a national systemic lupus erythematosus cohort. Lupus. 2018;27(11):1819–27.

Youssef J, Novosad SA, Winthrop KL. Infection Risk and Safety of Corticosteroid Use. Rheumatic Disease Clinics of North America [Internet]. 2016;42(1):157–76. Available from: http://dx.doi.org/10.1016/j.rdc.2015.08.004

Sharma A. Oral candidiasis: An opportunistic infection: A review. International Journal of Applied Dental Sciences. 2019;5(1):23–7.

Yamane Y, Matsukura S, Watanabe Y, Yamaguch Y, Nakamura K, Kambara T, et al. Retrospective analysis of Stevens-Johnson syndrome and toxic epidermal necrolysis in 87 Japanese patients - Treatment and outcome. Allergology International [Internet]. 2016;65(1):74–81. Available from: http://dx.doi.org/10.1016/j.alit.2015.09.001

Edmiston CE, Bruden B, Rucinski MC, Henen C, Graham B, Lewis BL. Reducing the risk of surgical site infections: Does chlorhexidine gluconate provide a risk reduction benefit? Am J Infect Control [Internet]. 2013;41(5 SUPPL.):S49–55. Available from: http://dx.doi.org/10.1016/j.ajic.2012.10.030

Stabler S. Vitamin B 12 Deficiency. N Engl J Med. 2013;368(2):149–60.

Hoffman JJ, Yadav R, Das Sanyam S, Chaudhary P, Roshan A, Singh SK, et al. Topical chlorhexidine 0.2% versus topical natamycin 5% for fungal keratitis in Nepal: rationale and design of a randomised controlled non-inferiority trial. BMJ Open. 2020 Sep 30;10(9):e038066.

American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;27(1):5–10.

Zibaei M, Bahadory S, Saadati H, Pourrostami K, Firoozeh F, Foroutan M. Intestinal parasites and diabetes: A systematic review and meta-analysis. New Microbes New Infect. 2023 Jan 1;51.

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Published

2024-08-31

How to Cite

Rahmi Harmiyati, Fika Faradillah Drakel, & Riani Setiadhi. (2024). Oral Complications Due to Medication in Stevens-Johnson Syndrome Patient with Systemic Involvement. DENTA JURNAL KEDOKTERAN GIGI, 18(2), 93–99. https://doi.org/10.30649/denta.v18i2.6

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