title: [Stevens-Johnson syndrome and toxic epidermal necrolysis (SJSTEN) related to insecticide: Second case in the literature and potential implications].
abstract: BACKGROUND
  Stevens-Johnson syndrome and toxic epidermal necrolysis (SJSTEN) is a rare acute drug reaction characterized by the brutal destruction of the superficial layer of the skin and mucosa. SJSTEN is favoured by some drugs (90 % of cases) and genetic factors. It occurs at any age in both sexes. The pathophysiology is not completely understood. To our knowledge, only one case linked to an insecticide has been described. We present the second case involving a combination of lambdacyhalothrin and thiamethoxam.
  
  
  METHODS
  A 34-year-old farmer was admitted in emergency for a severe allergic reaction occurring few days after the use of an insecticide to treat his field with no particular precaution. The disease progression was swift: deterioration of general condition, generalized itching, blisters, bubbles, hyperthermia, tachycardia, significant oral pain and oral lesions and dysphagia. Hands, feet were concerned and external genitalia was responsible for burning urination. Oral lesions have rapidly evolved from edema to infected lesions. The diagnosis of SJSTEN was confirmed by histopathology. After complete assessment and adequate treatment, the patient was discharged after 17 days of hospitalization. The etiological research concluded to a probable poisoning by lambdacyhalothrin and thiamethoxam.
  
  
  CONCLUSIONS
  This is the second published case of a SJSTEN linked to an insecticide combining lambdacyhalothrin and thiamethoxam. Manufacturers, users, regulators and physicians should take these data into account.
authors.affiliation: Service d'odontologie, de médecine buccale et chirurgie orale, CHU de Dijon, boulevard de Lattre-de-Tassigny, 21000 Dijon, France. Electronic address: malikamoullan@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Moullan
authors.affiliation: Service d'odontologie, de médecine buccale et chirurgie orale, CHU de Dijon, boulevard de Lattre-de-Tassigny, 21000 Dijon, France.
authors.forename: V
authors.initials: V
authors.lastname: Ahossi
authors.affiliation: University Bourgogne-Franche-Comté, Lipids Nutrition Cancer team NuTox UMR86, 6, boulevard Jeanne-d'Arc, 21000 Dijon, France; CHU Dijon, Service chirurgie maxillo-faciale, plastique-reconstructrice et esthétique, boulevard de Lattre-de-Tassigny, 21000 Dijon, France.
authors.forename: N
authors.initials: N
authors.lastname: Zwetyenga
mesh_terms: D000328:Adult; D006801:Humans; D007306:Insecticides / Q000506:poisoning*; D008297:Male; D000073943:Neonicotinoids; D009570:Nitriles / Q000506:poisoning; D009574:Nitro Compounds / Q000506:poisoning; D010078:Oxazines / Q000506:poisoning; D011722:Pyrethrins / Q000506:poisoning; D012867:Skin / Q000187:drug effects* / Q000473:pathology*; D013262:Stevens-Johnson Syndrome / Q000175:diagnosis* / Q000209:etiology; D000077922:Thiamethoxam; D013844:Thiazoles / Q000506:poisoning
chemical_list: D007306:Insecticides; D000073943:Neonicotinoids; D009570:Nitriles; D009574:Nitro Compounds; D010078:Oxazines; D011722:Pyrethrins; D013844:Thiazoles; D000077922:Thiamethoxam; C037304:cyhalothrin
keywords: Agriculture; Farming; Insecticide; Lambdacyhalothrine; Stevens-Johnson syndrome; Syndrome de Lyell; Syndrome de Stevens-Johnson; Thiamethoxam; Thiaméthoxam