Discussion
TEN is a dermatological emergency mediated predominantly by CD8+ T
lymphocytes and is associated with an average mortality of
25%.2,3 Patients carrying susceptible specific
haplotypes, cross-reactivity between the drugs with very similar
stereochemical structures, and drug metabolites generated by the
Cytochrome P450 enzyme complex may influence the recurrence of SJS
and/or TEN.2
Our patient had 2 episodes of TEN following intake of Furosemide at
present and Nimesulide 3 years back. Literature search revealed a
similar chemical structure in Nimesulide and Furosemide as both the drug
molecule contains the sulfonamide functional group
(R−S(=O) 2−NR 2) which might have
triggered the second episode in our patient.4,5 In our
patient, the skin lesions in the second episode of TEN appeared earlier
as compared to the usual duration reported in the literature. The cause
of the short latency period may be attributed to the sensitization of
the patient to the sulfonamide group of drugs in the first episode. Our
patient lacked constitutional symptoms and mucocutaneous involvement was
less severe as compared to the first episode which might be due to the
early presentation of the patient to our center along with early
therapeutic intervention.