Stevens-Johnson Syndrome/Toxic epidermal necrolysis complicated with fulminant type 1 diabetes mellitus: a case report and literature review.

IF 2.8 3区医学 Q3 ENDOCRINOLOGY & METABOLISM BMC Endocrine Disorders Pub Date : 2024-09-02 DOI:10.1186/s12902-024-01683-5

Xiaofang Zhang, Dihua Huang, Dajun Lou, Xuwei Si, Jiangfeng Mao

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Abstract

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but life-threatening skin lesion triggered by hypersensitive drug reaction. They are characterized by extensive epidermal necrosis and skin exfoliation. Fulminant type 1 diabetes mellitus (FT1DM) is featured by a rapid-onset of hyperglycemia with ketoacidosis due to severely destroyed β-cell function. Fulminant type 1 diabetes mellitus as a sequela of SJS/TEN has rarely been reported.

Case presentation: We present a 73-year-old female patient who developed SJS/TEN skin allergic reaction after taking carbamazepine and phenytoin for 35 days. Then, hyperglycemia and diabetic ketoacidosis occurred 20 days after discontinuation of antiepileptic drugs. A very low serum C-peptide level (8.79 pmol/l) and a near-normal glycosylated hemoglobin level met the diagnostic criteria for fulminant T1DM. Intravenous immunoglobulin (IVIG) and insulin were promptly administered, and the patient recovered finally.

Conclusions: This rare case indicates that monitoring blood glucose is necessary in SJS/TEN drug reaction, and comprehensive therapy with rehydration, insulin, antibiotics, and IVIG may improve the prognosis.

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史蒂文斯-约翰逊综合征/毒性表皮坏死溶解症并发暴发性 1 型糖尿病：病例报告和文献综述。

背景：史蒂文斯-约翰逊综合征（SJS）和中毒性表皮坏死溶解症（TEN）是一种罕见的、由药物过敏反应引发的危及生命的皮肤病变。它们的特点是表皮大面积坏死和皮肤脱落。暴发性1型糖尿病（FT1DM）的特点是由于β细胞功能严重受损而迅速出现高血糖和酮症酸中毒。作为 SJS/TEN 后遗症的恶性 1 型糖尿病鲜有报道：本病例是一名 73 岁的女性患者，在服用卡马西平和苯妥英 35 天后出现 SJS/TEN 皮肤过敏反应。停用抗癫痫药物 20 天后出现高血糖和糖尿病酮症酸中毒。极低的血清 C 肽水平（8.79 pmol/l）和接近正常的糖化血红蛋白水平符合暴发性 T1DM 的诊断标准。医生迅速为患者注射了静脉免疫球蛋白（IVIG）和胰岛素，患者最终康复：这一罕见病例表明，在 SJS/TEN 药物反应中必须监测血糖，补液、胰岛素、抗生素和 IVIG 等综合治疗可改善预后。

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来源期刊

BMC Endocrine Disorders ENDOCRINOLOGY & METABOLISM-

CiteScore

4.40

自引率

0.00%

发文量

280

审稿时长

>12 weeks

期刊介绍： BMC Endocrine Disorders is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of endocrine disorders, as well as related molecular genetics, pathophysiology, and epidemiology.