Undiagnosed and Rare Diseases in Critical Care: Severe Mucocutaneous Medication Reactions

Bridget E Shields; Karolyn A Wanat; Yvonne E Chiu

doi:10.1016/j.ccc.2021.11.003

Undiagnosed and Rare Diseases in Critical Care: Severe Mucocutaneous Medication Reactions

Crit Care Clin. 2022 Apr;38(2):243-269. doi: 10.1016/j.ccc.2021.11.003.

Authors

Bridget E Shields¹, Karolyn A Wanat², Yvonne E Chiu³

Affiliations

¹ Department of Dermatology, University of Wisconsin, 1 South Park Street, Madison, WI 53703, USA. Electronic address: bshields@dermatology.wisc.edu.
² Department of Dermatology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; Department of Pathology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
³ Department of Dermatology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.

PMID: 35369946
DOI: 10.1016/j.ccc.2021.11.003

Abstract

There have been major advances in the understanding of severe cutaneous adverse reactions (SCARs). Early recognition and withdrawal of culprit medications can decrease morbidity and mortality significantly. SCARs encompass a variety of entities that present with extensive mucocutaneous involvement and systemic symptoms, often requiring management in an intensive care setting. Physicians need to recognize SCARs early in their course, including drug reaction with eosinophilia and systemic symptoms, Stevens-Johnson syndrome, and toxic epidermal necrolysis, and their mimicking conditions. This review focuses on common and rare SCARs with an emphasis on defining features, clinical and diagnostic evaluation, treatment, and long-term sequelae.

Keywords: Drug reaction with eosinophilia and systemic symptoms (DRESS); Drug-induced hypersensitivity syndrome (DIHS); Methotrexate-induced epidermal necrosis (MEN); Reactive infectious mucocutaneus eruption (RIME); Stevens-Johnson syndrome (SJS); Toxic-epidermal necrolysis (TEN).

Publication types

Review

MeSH terms

Critical Care
Humans
Rare Diseases* / diagnosis
Rare Diseases* / therapy
Stevens-Johnson Syndrome* / diagnosis
Stevens-Johnson Syndrome* / etiology
Stevens-Johnson Syndrome* / therapy