Severe cutaneous adverse drug reactions: A search for the culprit in a retrospective study of 107 patients
Ghita Sqalli Houssini¹, Zakia Douhi¹, Meryem Soughi¹, Sara Elloudi¹, Hanane Baybay¹, Badreddine Moukafi h², Marwa Elbaldi³, Karima El Rhazi³, Fatima Zahra Mernissi¹

1 Dermatology and Venereology Department, Hassan II University Hospital Center, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
2 Anatomy and Cytopathology Department, Hassan II University Hospital Center, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
3 Epidemiology and Public Health Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco

ABSTRACT
Background: Severe drug eruptions, posing life-threatening risks, necessitate immediate discontinuation. This study (2014–2023) examined clinical profiles and prognoses in Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome, Stevens–Johnson (SJS) syndrome, Toxic Epidermal Necrolysis (Lyell’s syndrome), and Acute Generalized Exanthematous Pustulosis (AGEP). Materials and Methods: A retrospective analysis included hospitalized patients with severe drug reactions. Results: Implicated drugs: allopurinol (44.9%), neuroleptics (20.6%), antibiotics (12.1%), sulfasalazine (5.6%), and NSAIDs (5.6%). Allopurinol dominated in DRESS syndrome (51.4%), SJS (35.3%), Lyell’s syndrome (45.5%). Neuroleptics caused SJS (35.3%), Lyell’s syndrome (27.3%), and DRESS syndrome (18.1%). Antibiotics linked to AGEP (28.6%), SJS (17.6%), Lyell’s syndrome (9.1%), and DRESS syndrome (9.7%). Sulfasalazine was associated with SJS (9.0%) and DRESS syndrome (6.9%), NSAIDs with AGEP (42.9%), and DRESS syndrome (4.2%). Significant correlations included sulfasalazine with hepatic impairment and allopurinol, neuroleptics, and antibiotics with renal failure. Mortality was 9.3%, primarily from allopurinol (60%), antibiotics (20%), and sulfasalazine (20%). Conclusion: Allopurinol and neuroleptics pose higher risks with significant correlations to severe complications. Haut du formulaire.
Key words: Drugs, Culprit, Allopurinol, DRESS syndrome, Stevens–Johnson syndrome, Lyell’s syndrome

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