Index > Vol. 89/2009 > Iss. 3/May > pp. 285-287 > Abstract
Clinical Report | Skin biology and inflammation, Drug development and adverse reactions

Neopterin and C-Reactive Protein in the Course of Stevens-Johnson Syndrome: Report of a Case

doi: 10.2340/00015555-0631

Abstract:

We describe a patient originally suffering from a depressive syndrome who developed Stevens-Johnson syndrome after 12 days of treatment with lamotrigine. The clinical symptoms and the inflammation parameters neopterin and C-reactive protein were documented. Neopterin values showed a good correlation with the course of the disease, which, to the best of our knowledge, has not been reported previously. C-reactive protein followed the neopterin curve with a delay of 4 days. Since neopterin is a widely available parameter it should be considered as a routine measurement in this type of hyperergic reaction. It might help to identify the beginning, the maximum and the regression of the disease in order to support therapeutic decisions.

Authors:

Linda Bertram, Yvonne Liss and Michael Grözinger

Key words:

Stevens-Johnson syndrome; toxic epidermal necrolysis; neopterin; C-reactive protein; inflammation marker.

References

  1. Mockenhaupt M, Viboud C, Dunant A, Naldi L, Halevy S, Bouwes Bavinck JN, et al. Stevens-Johnson syndrome and toxic epidermal necrolysis: assessment of medication risks with emphasis on recently marketed drugs. The EuroSCAR-study. J Invest Dermatol 2008; 128: 35–44. Link to article
  2. Bastuji-Garin S, Rzany B, Stern RS, Shear NH, Naldi L, Roujeau JC. Clinical classification of cases of toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme. Arch Dermatol 1993; 129: 92–96. Link to article
  3. Pereira FA, Mudgil AV, Rosmarin DM. Toxic epidermal necrolysis. J Am Acad Dermatol 2007; 56: 181–200.
  4. Mockenhaupt M, Messenheimer J, Tennis P, Schlingmann J. Risk of Stevens-Johnson syndrome and toxic epidermal necrolysis in new users of antiepileptics. Neurology 2005; 64: 1134–1138.
  5. Rzany B, Correia O, Kelly JP, Naldi L, Auquier A, Stern R. Risk of Stevens-Johnson syndrome and toxic epidermal necrolysis during first weeks of antiepileptic therapy: a case-control study. Study Group of the International Case Control Study on Severe Cutaneous Adverse Reactions. Lancet 1999; 353: 2190–2194. Link to article
  6. Chang CC, Shiah IS, Chang HA, Huang SY. Toxic epidermal necrolysis with combination lamotrigine and valproate in bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry 2006; 30: 147–150. Link to article
  7. Varghese SP, Haith LR, Patton ML, Guilday RE, Ackerman BH. Lamotrigine-induced toxic epidermal necrolysis in three patients treated for bipolar disorder. Pharmacotherapy 2006; 26: 699–704.
  8. Petkov T, Pehlivanov G, Grozdev I, Kavaklieva S, Tsankov N. Toxic epidermal necrolysis as a dermatological manifestation of drug hypersensitivity syndrome. Eur J Dermatol 2007; 17: 422–427.
  9. Fuchs D, Weiss G, Wachter H. Neopterin, biochemistry and clinical use as a marker for cellular immune reactions. Int Arch Allergy Immunol 1993; 101: 1–6.
  10. Huber C, Batchelor JR, Fuchs D, Hausen A, Lang A, Niederwieser D, et al. Immune response-associated production of neopterin. Release from macrophages primarily under control of interferon-gamma. J Exp Med 1984; 160: 310–316. Link to article
  11. Wirleitner B, Reider D, Ebner S, Bock G, Widner B, Jaeger M, et al. Monocyte-derived dendritic cells release neopterin. J Leukoc Biol 2002; 72: 1148–1153.
  12. Fuchs D, Stahl-Hennig C, Gruber A, Murr C, Hunsmann G, Wachter H. Neopterin – its clinical use in urinalysis. Kidney Internat 1994; 47: S8–S11.
  13. Berdowska A, Zwirska-Korczala K. Neopterin measurement in clinical diagnosis. J Clin Pharm Ther 2001; 26: 319–329. Link to article
  14. Hoffmann G, Wirleitner B, Fuchs D. Potential role of immune system activation-associated production of neopterin derivatives in humans. Inflamm Res 2003; 52: 313–321.
  15. Czelej D, Chodorowska G, Lecewicz-Torun B. Plasma activity of interleukin-6 and some acute phase proteins in severe drug-induced skin adverse reactions. Ann Univ Mariae Curie Sklodowska [Med] 2002; 57: 62–67.
  16. Paul C, Wolkenstein P, Adle H, Wechsler J, Garchon HJ, Revuz J, et al. Apoptosis as a mechanism of keratinocyte death in toxic epidermal necrolysis. Br J Dermatol 1996; 134: 710–714.Link to article