Intravenous N-acetylcysteine in severe cutaneous drug reaction treatment: A case series

Abstract

Drug-induced serious adverse reaction is an unpleasant event with high rate of mortality. Stevens-Johnson Syndrome and toxic epidermal necrolysis are most common among the serious adverse drug reactions. There is no selective drug therapy for the management of serious adverse drug reactions-associated mucocutaneous blisters. The use of N-acetylcysteine in the treatment of mucocutaneous blisters has limited evidence worldwide. Three cases of toxic epidermal necrolysis or Stevens-Johnson Syndrome-associated mucocutaneous blisters are presented in this study where intravenous N-acetylcysteine (600 mg, every 8 h) was given in early hospitalization hours for the treatment of mucocutaneous fluid-filled blisters. Here, one patient with toxic epidermal necrolysis received intravenous immunoglobulin along with intravenous N-acetylcysteine and the other two patients (toxic epidermal necrolysis/Stevens-Johnson Syndrome) received only N-acetylcysteine intravenously. In response, mucocutaneous fluid-filled blisters stopped progressing within 48 h and were healed within 2 weeks of admission in the intensive care unit. Thus, intravenous N-acetylcysteine with or without having intravenous immunoglobulin in the treatment of serious adverse drug reactions-associated mucocutaneous blisters may be an effective therapeutic option for better clinical outcome.

Keywords: N-acetylcysteine; Serious adverse drug reactions; Stevens–Johnson syndrome; mucocutaneous blister; toxic epidermal necrolysis.

Figure 1.

(a) Mucocutaneous blisters at the time of admission in ICU. (b) Healing of fluid-filled blisters after 48 h of admission. (c) Complete re-epithelialization of the lesions on 12th day of admission.

Figure 2.

(a) Mucocutaneous blisters at the time of admission in ICU. (b) Healed blisters after 48 h of admission. (c) Day 9 of admission with complete re-epithelialization of the lesions.

Figure 3.

(a) Mucocutaneous blisters at the time of admission in ICU. (b) Healed blisters after 48 h of admission. (c) Day 4 of admission with suppressed skin lesions.