1216 - Olanzapine-Induced SJS/TEN: An Uncommon Reaction to a Common Medication

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

Case Description:

A 45-year-old female with a past medical history of polysubstance use disorder and cirrhosis presented to the emergency department after developing a dusky, confluent maculopapular rash of the abdomen and proximal extremities with hemorrhagic bullae of the feet 25 days after starting Olanzapine for anxiety. The hospital course was complicated by mucosal involvement and acute blood loss anemia requiring numerous transfusions. Skin punch biopsy revealed necrotic keratinocytes, consistent with Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN). Given prompt recognition, treatment included intravenous immunoglobulin and systemic corticosteroids. The wounds precluded left lower extremity weightbearing, requiring acute inpatient rehabilitation (AIR) for further management and aggressive wound care. The AIR hospital course was uncomplicated; progressive wound healing allowed for weightbearing as tolerated and she successfully returned home.

Discussions:

Olanzapine is often utilized in the AIR setting for various indications such as psychiatric conditions, acute agitation, central vertigo, or nausea. SJS/TEN is a rare, T-cell mediated, severe cutaneous adverse reaction with a mortality rate of 12 to 49 percent. Although typically triggered by antibiotic or anti-epileptic medications, a variety of drugs have been postulated as an etiology of SJS/TEN. Olanzapine is a commonly prescribed atypical antipsychotic frequently associated with metabolic ramifications, but there is a modicum of literature linking Olanzapine to dermatologic reactions, with no specific published cases of Olanzapine-induced SJS/TEN. The only new medication introduced to our patient was Olanzapine. Timely diagnosis allowed for discontinuation of the offending agent and appropriate management, ultimately preventing further morbidity.

Conclusions:

Physiatrists should know about this possible critical complication of Olanzapine because it is a frequently employed medication in the AIR patient population. SJS/TEN is a rare, but life-threatening, adverse reaction and early identification can minimize long-term consequences for afflicted patients.