Severe idiosyncratic drug reaction (Lyells syndrome) after ingesting dihydroartemisinin

Abstract

Lyells syndrome also called Toxic epidermal necrolysis is the extreme formof idiosyncratic drug reaction that is called Steven Johnsons Syndrome. The condition results in an extensive loss of the skin with mucous membrane involvement. Lyells syndrome has been induced by many agents. The commonest agent in the literature being sulphonamides. However, in our search of the medical literature there was no report of dihydroarthemisinin as a cause ofLyells syndrome.
We report three patients seen at two tertiary health institutionswith Lyells syndrome after treatment formalaria with dihydroarthemisinin. This resulted from administration of dihydroarthemisinin with chloroquine in two
patients and dihydroarthemisinin withAmodiaquine in one patient. The first patientwas a seven year old child who developed90%cutaneous involvement and died fromhemorrhagic shock.The secondwas a 28 old female that developed a 76% body surface involvement and died from septicemia. The third patient was a pregnant 37year old woman that developed 52% body involvement and died from septic shock. In these patients the earliest symptomswere not recognized and therewas considerable delay before referral. In view of the recent WHO recommendation of Arthemisinin Combination Treatment (ACT) for malaria, we expect more cases of Steven Johnson Syndrome and Lyells syndrome from ACT treatment. The aim of this report is to raise the awareness of clinicians to this potentially fatal complication.