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.