A case of toxic epidermal necrolysis induced by losartan and furosemide in patient with chronic renal failure: case report

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  • Nakashima Hejin
    Division of Nephrology, Department of Medicine, Kurume University School of Medicine
  • Koike Kiyomi
    Division of Nephrology, Department of Medicine, Kurume University School of Medicine
  • Fukami Kei
    Division of Nephrology, Department of Medicine, Kurume University School of Medicine
  • Kusumoto Takuo
    Division of Nephrology, Department of Medicine, Kurume University School of Medicine
  • Hazama Takuma
    Division of Nephrology, Department of Medicine, Kurume University School of Medicine
  • Matsumoto Takashi
    Division of Nephrology, Department of Medicine, Kurume University School of Medicine
  • Ueda Seiji
    Division of Nephrology, Department of Medicine, Kurume University School of Medicine
  • Okuda Seiya
    Division of Nephrology, Department of Medicine, Kurume University School of Medicine

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Other Title
  • ロサルタン，フロセミドによる中毒性表皮壊死症(TEN)を発症した慢性腎不全患者の1症例
  • 症例報告 ロサルタン,フロセミドによる中毒性表皮壊死症(TEN)を発症した慢性腎不全患者の1症例
  • ショウレイ ホウコク ロサルタン,フロセミド ニ ヨル チュウドクセイ ヒョウヒ エシショウ(TEN)オ ハッショウ シタ マンセイ ジンフゼン カンジャ ノ 1 ショウレイ

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Abstract

Toxic epidermal necrolysis (TEN) is a serious and potentially fatal drug side effect in patients with chronic renal failure (CRF). This is the first report to show that losartan and furosemide induced TEN in a CRF patient. A 76-year-old man was administered losartan and furosemide for hypertension and leg edema. Nine days later, severe skin sores and ulceration were observed, and were diagnosed as drug-induced TEN. Drugs including losartan and furosemide were immediately stopped. However, renal function rapidly deteriorated. We started oral steroids and steroid pulse therapy. Since steroid therapy did not improve the progression of TEN, we performed plasmapheresis and administered an intravenous injection of immunoglobulin (IVIg) for oral infectious mucosal pus. The drug-induced lymphocyte stimulation test (DLST) for losartan and furosemide was positive. Here we report for the first time that losartan and furosemide induced TEN in a CRF patient. Drug-induced TEN may occur in patients with renal dysfunction because of reduced drug metabolism and/or polypharmacy in these patients. As such, care should be taken when selecting drugs for the treatment of CRF patients.

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