Allergy Asthma Respir Dis AARD Allergy, Asthma & Respiratory Disease 2288-0402 2288-0410 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology 10.4168/aard.2016.4.3.221 Case Report Toxic epidermal necrolysis induced by deflazacort Youn Dail Kim Min-Hye Koh Seok Woong Kim Jung Won Yoon Sang Eun Jeon Hyeon Kyeong http://orcid.org/0000-0002-9414-5934 Cho Young-Joo Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea. Correspondence to: Young-Joo Cho. Department of Internal Medicine, Ewha Womans University School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Korea. Tel: +82-2-2650-5011, Fax: +82-2-2655-2076, yjcho@ewha.ac.kr 05 2016 31 05 2016 4 3 221 224 17 12 2015 02 02 2016 16 02 2016 © 2016 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology 2016 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions to drugs, which carry significant morbidities and mortalities. Although SJS and TEN can be treated by corticosteroids or intravenous immunoglobulin, they may be induced by steroids. We experienced a 36-year-old man who developed whole body erythromatous maculopapular rashes and multiple bullae after ingestion of deflazacort. After avoidance of deflazacort and use of dexamethasone, skin lesions resorbed. We reported a case of TEN diagnosed by characteristic clinical findings with a brief review of the literature.

 Stevens-Johnson syndrome Nephrotic syndrome Drug hypersensitivity syndrome Letko E Papaliodis DN Papaliodis GN Daoud YJ Ahmed AR Foster CS Stevens-Johnson syndrome and toxic epidermal necrolysis: a review of the literature Ann Allergy Asthma Immunol 2005 94 419 436 Yang MS Jung JW Kang HR Severe cutaneous adverse reaction Korean J Med 2014 87 665 674 Schwartz RA McDonough PH Lee BW Toxic epidermal necrolysis: part II. Prognosis, sequelae, diagnosis, differential diagnosis, prevention, and treatment J Am Acad Dermatol 2013 69 187.e1 187.e6 Roujeau JC Kelly JP Naldi L Rzany B Stern RS Anderson T Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis N Engl J Med 1995 333 1600 1607 Khalili B Bahna SL Pathogenesis and recent therapeutic trends in Stevens-Johnson syndrome and toxic epidermal necrolysis Ann Allergy Asthma Immunol 2006 97 272 280 Navarro Llanos A Elizalde Eguinoa J Boto de los Bueys B Pujol de la Llave E Toxic epidermal necrolysis in a patient treated with high doses of deflazacort Med Clin (Barc) 1996 106 599 Kim DW Jung DE Koo JW Steroid and enalapril therapy: possible cause of toxic epidermal necrolysis Korean J Pediatr 2006 49 332 336 Lee EC Kim GA Koo JW Toxic epidermal necrolysis associated with deflazacort therapy with nephrotic syndrome Kidney Res Clin Pract 2014 33 222 225 Edwards IR Aronson JK Adverse drug reactions: definitions, diagnosis, and management Lancet 2000 356 1255 1259 Borchers AT Lee JL Naguwa SM Cheema GS Gershwin ME Stevens-Johnson syndrome and toxic epidermal necrolysis Autoimmun Rev 2008 7 598 605 Schwartz RA McDonough PH Lee BW Toxic epidermal necrolysis: part I. Introduction, history, classification, clinical features, systemic manifestations, etiology, and immunopathogenesis J Am Acad Dermatol 2013 69 173.e1 173.e13 Faye O Roujeau JC Treatment of epidermal necrolysis with high-dose intravenous immunoglobulins (IV Ig): clinical experience to date Drugs 2005 65 2085 2090 Jat KR Khairwa A Deflazacort in comparison to other steroids for nephrotic syndrome Indian J Nephrol 2012 22 239 245 Browne F Wilkinson SM Effective prescribing in steroid allergy: controversies and cross-reactions Clin Dermatol 2011 29 287 294 Buttoni U Pulsoni A Innocenzi D Pranteda G Latini A Bonaccorsi P Toxic epidermal necrolyis (TEN) in a patient with non-Hodgkin lymphoma: successful treatment with dexamethasone at high dosage J Eur Acad Dermatol Venereol 2000 14 140 142 van der Meer JB Schuttelaar ML Toth GG Kardaun SH Beerthuizen G de Jong MC Successful dexamethasone pulse therapy in a toxic epidermal necrolysis (TEN) patient featuring recurrent TEN to oxazepam Clin Exp Dermatol 2001 26 654 656 Barman KD Verma KK Agrawal S Agarwalla A Rijal A Stevens-Johnson syndrome with idiopathic thrombocytopenic purpura treated with dexamethasone pulse therapy J Dermatol 2003 30 54 58 Kardaun SH Jonkman MF Dexamethasone pulse therapy for Stevens-Johnson syndrome/toxic epidermal necrolysis Acta Derm Venereol 2007 87 144 148 Lauerma AI Reitamo S Maibach HI Systemic hydrocortisone/cortisol induces allergic skin reactions in presensitized subjects J Am Acad Dermatol 1991 24 2 Pt 1 182 185 Koh WL Tay YK Koh MJ Danazol-induced Stevens-Johnson syndrome in a patient with systemic lupus erythematosus Dermatol Online J 2015 21 1 pii: 13030/qt24v513b9 Patient's whole body showed erythromatous maculopapular rash and multiple bullae at admission.