title: Toxic epidermal necrolysis due to therapy with cyclophosphamide and mesna. A case report of a patient with seronegative rheumatoid arthritis and rheumatoid vasculitis.
abstract: Rheumatoid vasculitis usually occurs on the background of seropositive rheumatoid arthritis, although in rare cases the patients can be seronegative. We report a woman with seronegative rheumatoid arthritis with rheumatoid vasculitis who developed toxic epidermal necrolysis involving most of her body surface area, while on therapy with intravenous cyclophosphamide and mesna. After withdrawal of suspected offending agents, administration of intravenous immunoglobulin, and supportive therapy, she had a favorable outcome. Such an occurrence is rare and serves to educate about a potentially life-threatening adverse event associated with a commonly used immunosuppressive agent.
authors.affiliation: Department of Clinical Immunology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Rae Bareily Road, 226 014, Lucknow, Uttar Pradesh, India.
authors.forename: A C
authors.initials: AC
authors.lastname: Chowdhury
authors.affiliation: Department of Clinical Immunology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Rae Bareily Road, 226 014, Lucknow, Uttar Pradesh, India. durgapmisra@gmail.com.
authors.forename: D P
authors.initials: DP
authors.lastname: Misra
authors.affiliation: Department of Clinical Immunology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Rae Bareily Road, 226 014, Lucknow, Uttar Pradesh, India.
authors.forename: P S
authors.initials: PS
authors.lastname: Patro
authors.affiliation: Department of Clinical Immunology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Rae Bareily Road, 226 014, Lucknow, Uttar Pradesh, India.
authors.forename: V
authors.initials: V
authors.lastname: Agarwal
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000188:drug therapy; D003520:Cyclophosphamide / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D015080:Mesna / Q000009:adverse effects* / Q000627:therapeutic use; D020011:Protective Agents / Q000009:adverse effects / Q000627:therapeutic use; D056653:Rheumatoid Vasculitis / Q000097:blood / Q000188:drug therapy*; D013262:Stevens-Johnson Syndrome / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D020011:Protective Agents; D003520:Cyclophosphamide; D015080:Mesna
keywords: Adverse drug reaction; Immunoglobulin; Immunosuppressive agents; Rheumatoid vasculitis; Seronegative rheumatoid vasculitis