Glimepiride
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Toxic epidermal necrolysis: case report A 76-year-old woman developed developed toxic epidermal necrolysis (TEN) during treatment with glimepiride for steroid diabetes. The woman, who had a history of hypersensitivity reaction related to cotrimoxazole in 2013 and diabetes, presented with persistent hyperglycaemia in 2016. She started receiving glimepiride 1 mg/day [route not stated] with metformin. A week after glimepiride initiation, she developed localised pruritic skin rash, which was not resolved by unspecified antihistaminic agent. Her skin reaction worsened and generalised with multiple brownish lesions and blisters. Mucosal involvement of the ocular and buccal epithelium was noted. She was admitted to the ICU. She was diagnosed with TEN related to glimepiride. Metformin and glimepiride were discontinued. On admission, the woman was disoriented, febrile and had dyspnoea. A diffuse brownish and erythematous rash with confluent blisters affected more than 95% of total body surface area (BSA) with detachment of the epidermal surface. Nikolsky’s sign was positive. Various laboratory investigations were performed which turned normal. After the initial laboratory test result, severity-of-illness score for toxic epidermal necrolysis (SCORTEN) was 5. The diagnosis of TEN was confirmed [durations of treatments to reactions onsets not stated]. She was treated with unspecified IV fluids, unspecified corticosteroids and unspecified antibacterials. The next day, her condition worsened. She developed acute respiratory failure and required intubation, acute kidney failure with anuria and severe hepatocellular injury. Two days later, she died due to multiorgan failure. Ouni B, et al. Fatal toxic epidermal necrolysis probably related to glimepiride in a patient with a medical history of hypersensitivity to sulfamethoxazole-trimethoprim. British Journal of Clinical Pharmacology : Jan 2020. Available from: URL: http://doi.org/10.1111/bcp.14499 803501286
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Reactions 19 Sep 2020 No. 1822
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