Korean J Gastroenterol.  1998 Jan;31(1):130-135.

A Case of Piroxicam Induced Toxic Epidermal Necrolysis with Toxic Hepatitis and Upper Gastrointestinal Bleeding

• Chung JM
• Kweon YO
• Geum MS
• Cho JH
• Kim DH
• Lee CH
• Kweon S
• Kim SK
• Choi YH

Abstract

Drug-induced toxic epidermal necrolysis (TEN) is one of the most severe mucocutaneous diseases characterized by progressive epidermal detachment with the involvement of multiple internal organs and poor prognosis. There are few reports of drug-induced toxic epidermal necrolysis with upper gastrointestinal bleeding and toxic hepatitis simultaneously. We experienced a case of piroxicam-induced TEN with upper gastrointestinal bleeding and toxic hepatitis in a previously healthy 61 year-old woman. The patient was admitted with nausea, vomiting and a high transaminase level on liver function test after two weeks of medication with piroxicam, and showed progressive erythematous rnaculopapular, vesiculobullous skin lesions on the face at first and the lesions spread to the neck and the trunk consecutively. Four.days after admission, hematemesis and melena developed. Upper gastrointestinal endoscopy showed diffuse mucosal erosions and shallow ulcerations in the esophagus, stomach and diffuse mucosal nodularity in the duodenum. Liver biopsy showed mild lymphocytic infiltration in the portal area and an entrapped bile plug in the sinusoidal space which was consistent with drug-induced cholestatic hepatitis. The patient was treated with antibiotics, corticosteroids and other supportive managements and then recovered completely. We report this case with a review of the literatures.

Keyword

Piroxicam; Toxic epidermal necrolysis; Upper gastrointestinal mucosal lesion; Toxic hepatitis

MeSH Terms

Adrenal Cortex Hormones
Anti-Bacterial Agents
Bile
Biopsy
Drug-Induced Liver Injury*
Duodenum
Endoscopy, Gastrointestinal
Esophagus
Female
Hematemesis
Hemorrhage*
Hepatitis
Humans
Liver
Liver Function Tests
Melena
Middle Aged
Nausea
Neck
Piroxicam*
Prognosis
Skin
Stevens-Johnson Syndrome*
Stomach
Ulcer
Vomiting
Adrenal Cortex Hormones
Anti-Bacterial Agents
Piroxicam