J Korean Ophthalmol Soc.  2009 Dec;50(12):1881-1886. 10.3341/jkos.2009.50.12.1881.

Methazolamide-induced Stevens-Johnson Syndrome

• Seo YS
• Chang KC
• Chang MH

• KMID: 2213003
• DOI: http://doi.org/10.3341/jkos.2009.50.12.1881

Abstract

PURPOSE
To report three consecutive cases of methazolamide-induced Stevens-Johnson syndrome.
CASE SUMMARY
We describe three patients who were all prescribed methazolamide for treatment of ophthalmologic conditions. A 29-year-old man and a 47- year-old woman were prescribed methazolamide (100 mg/day) for the treatment of central serous chorioretinopathy (CSCR). A 66-year-old woman was prescribed methazolamide (100 mg/day) for acute glaucoma of the left eye for approximately two weeks. After taking the methazolamide, three patients were showed the pururitic maculopapular rashes on the whole body and the vesicular eruptions of the oral mucosa and conjunctiva. On the basis of medication histories, characteristic skin lesions and mucosal involvement, we diagnosed all three patients with methazolamide-induced Stevens-Johnson syndrome. All three patients were hospitalized and treated with intravenous steroids and antihistamines. Two of the three cases showed conjunctival pseudomembranes. In two cases, the skin lesions worsened during the first week of treatment, and then resolved without complications over the next two to three weeks. The condition of the 47-year-old female patient deteriorated rapidly to toxic epidermal necrolysis due to sensitivity to sulfa antibiotics. HLA- A24, B59 and Cw1 were detected in all three cases.
CONCLUSIONS
In 2008, domestic production of acetazolamide was halted in Korea. Because of this, methazolamide is expected to be prescribed by ophthalmologists more commonly than in previous years. Complete medical histories should be taken before prescribing methazolamide to patients. HLA typing should be conducted whenever possible to screen patients before prescription of methazolamide.

Keyword

HLA B59; Methazolamide; Stevens-Johnson syndrome

MeSH Terms

Acetazolamide
Adult
Aged
Anti-Bacterial Agents
Central Serous Chorioretinopathy
Conjunctiva
Epidermal Necrolysis, Toxic
Exanthema
Eye
Female
Glaucoma
Histamine Antagonists
Histocompatibility Testing
HLA-B Antigens
Humans
Korea
Methazolamide
Middle Aged
Mouth Mucosa
Prescriptions
Skin
Steroids
Stevens-Johnson Syndrome
Acetazolamide
Anti-Bacterial Agents
HLA-B Antigens
Histamine Antagonists
Methazolamide
Steroids

Figure

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  Figure 1. Methazolamide-induced Stevens-Johnson syndrome in a 29-year-man. He had influenza-like symptoms at the prodromal phase. Then at 10 days after taking the methazolamide for CSCR, erythematous papular rash had appeared on the trunk, face and extremities.

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  Figure 2. A 47-year-old female with CSCR. She had a history of drug sensitivity to sulfa antibiotics. Prodrome and skin symptoms started at only one day later after methazolamide used. The erythema became confluent (A), and the hemorrhagic bullae (arrow) developed on an erythematous base. Her lips (B) were covered with hemorrhagic crusts (*), and numerous vesicles and erosions (arrowhead) appeared on the oral mucosa. Her condition was aggravated to the toxic epidermal necrolysis (denuded area >50%).

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  Figure 3. A 66-year-old female was treated with the methazolamide for acute glaucoma of the left eye. Erythematous eruptions of various size appeared on her entire body. Erythema (arrowhead), vesicle(*) and conjunctival pseudomembrane (arrow) developed.

Reference

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