Reporting on Adverse Clinical Events

A 68-year-old woman developed a diffuse rash and a fever approximately 1 month after starting atorvastatin (20 mg nightly) following mitral valve replacement. Concurrent medications included digoxin (0.125 mg daily), furosemide (20 mg twice daily), potassium chloride (1 g twice daily), and warfarin (0.625 mg nightly). Laboratory findings included albumin (34.6 g/L), -glutamyl transpeptidase (45 units/L), glucose (13.24 mmol/L), creatine kinase MB subtype (18.0 units/L), creatine kinase (20 units/L), lactic dehydrogenase (398 units/L), sodium (135.9 mmol/L), leukocyte count (5.19  10/L), hemoglobin (98.0 g/L), platelet count (267 g/L), procalcitonin (0.130 ng/mL), and fibrinogen (4.35 g/L). Treatment included discontinuation of all drugs used prior to admission and administration of loratadine (10 mg daily), cetirizine (10 mg daily), vitamin C (100 mg 3 times daily), methylprednisolone (120 mg every 12 hours), intravenous omeprazole (40 mg every 12 hours), calamine, and ethacridine. A large number of blisters covering greater than 30% of the body appeared the next day, accompanied by fever. Additional treatment included administration of intravenous human immunoglobulin. The facial skin began to peel, and the trunk blisters ruptured. Mupirocin was applied topically. A new red patchy rash appeared on the lower extremities. On day 17, the face of the skin and trunk was mostly healed. After 60 days, the skin had regrown. HLA allele detection revealed the HLA-A*2:07, HLA-A*11:01, HLAB*15:02, HLA-B*40:01, HLA-C*3:04, and HLA-C*08:01 alleles. The authors concluded that this case described toxic epidermal necrolysis associated with atorvastatin. They proposed that the mutant HLA genotypes carried may have a correlation with Stevens-Johnson syndrome and toxic epidermal necrolysis. Atorvastatin [“Lipitor”] Lv M et al (J Zhang, Department of Pharmacy, Fujian Medical University Union Hospital, #29 Xinquan Rd, Fuzhou 350001, China; e-mail: pollyzhang2006@126.com) Toxic epidermal necrolysis in a patient on atorvastatin expressing human leukocyte antigen alleles: a case report. Medicine (Baltimore) 100:e24391 (Jan) 2021