Abstract

Purpose

Acetaminophen (paracetamol) is a widely used analgesic and antipyretic. In several studies, its use was associated with the occurrence of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). This narrative review aimed to explore and summarise available cases of SJS/TEN suspected to be associated with acetaminophen reported in the literature.

Materials and methods

Electronic searches were conducted in PubMed/MEDLINE, Web of Science, Scopus and Serbian Citation Index (SCIndeks). Case reports or case series which reported detailed clinical description of the patients diagnosed with SJS, TEN or SJS/TEN overlap which was caused or suspected to be most likely caused by acetaminophen with available full text were included in the review.

Results

Twenty-nine publications describing a total of 36 patients which satisfied inclusion criteria were included in the review. The age of the patients ranged from 3 to 77 years (median: 32.5 years). There were 15 female (41.7%) and 15 male (41.7%) patients, while for 6 patients (16.7%) gender was not reported. TEN, SJS and SJS/TEN overlap were diagnosed in 24 (66.7%), 10 (27.8%) and 2 (5.6%) patients, respectively. Reported time from the first dose of acetaminophen to the onset of the first symptoms of SJS/TEN ranged from promptly to 21 days, with a median of 3 days. Use of some form of supportive and symptomatic care was reported in 28 patients (77.8%). Systemic corticosteroids were reported to be administered in 25 patients (69.4%) and intravenous immunoglobulin in 16 patients (44.4%). All patients survived. Long-term consequences (sequelae) were reported in 5 patients (13.9%).

Conclusions

Clinicians should be aware that SJS/TEN may be an adverse effect of acetaminophen and keep in mind that its prompt recognition and withdrawal of the culprit drug along with supportive care is of utmost importance.

中文翻译：

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对已发表的 Stevens-Johnson 综合征和与对乙酰氨基酚使用相关的中毒性表皮坏死松解症病例的回顾

摘要

目的

对乙酰氨基酚（扑热息痛）是一种广泛使用的镇痛剂和解热剂。在几项研究中，它的使用与 Stevens-Johnson 综合征 (SJS) 和中毒性表皮坏死松解症 (TEN) 的发生有关。这篇叙述性综述旨在探索和总结文献中报道的疑似与对乙酰氨基酚相关的 SJS/TEN 病例。

材料和方法

在 PubMed/MEDLINE、Web of Science、Scopus 和塞尔维亚引文索引 (SCIndeks) 中进行了电子检索。病例报告或病例系列报告了诊断为 SJS、TEN 或 SJS/TEN 重叠的患者的详细临床描述，这些患者由或怀疑最有可能由对乙酰氨基酚引起，并提供全文。

结果

共有 29 篇文献描述了符合纳入标准的 36 名患者。患者年龄从 3 岁到 77 岁不等（中位数：32.5 岁）。有15名女性（41.7%）和15名男性（41.7%）患者，而6名患者（16.7%）的性别未报告。分别在 24 名（66.7%）、10 名（27.8%）和 2 名（5.6%）患者中诊断出 10、SJS 和 SJS/TEN 重叠。报告的从第一剂对乙酰氨基酚到 SJS/TEN 的第一个症状发作的时间从迅速到 21 天不等，中位数为 3 天。28 名患者（77.8%）报告了使用某种形式的支持性和对症治疗。据报道，25 名患者 (69.4%) 使用了全身性皮质类固醇，16 名患者 (44.4%) 使用了静脉注射免疫球蛋白。所有患者均存活。

结论

临床医生应意识到 SJS/TEN 可能是对乙酰氨基酚的不良反应，并牢记其迅速识别和撤出罪魁祸首药物以及支持性护理至关重要。