Transcript
Etiologi• SJS-TEN is essentially drug-
induced. A few cases are related to infections (Mycoplasmapneumoniae), and a few other cases remain unexplained. HIV infection dramatically increases the risk. A predisposing effect of autoimmune disorders, such as systemic lupus, and an HLA-linked, genetic susceptibility have been also suggested.
Klauz Wolf dkk. Fritzpatrick`s Dermatology in General Medicine. 7th ed. McGraw-Hill Companies. USA; 2008.
Alergi Penisilin• Penisilin termasuk antibiotik β-lactam memiliki cincin β-lactam yang
secara kimiawi tidak stabil dan terbuka secara spontan membentuk intermediet reaktif yg berkombinasi dengan grup amino bebas yg larut atau protein yg berikatan dgn sel membentuk beberapa antigen, yg paling umum antigen penicilloyl bertindak sebagai hapten dalam reaksi hipersensitivitas terhadap penicillin
Munir Pirmohamed, PhD. PATHOGENESIS OF PENICILLIN ALLERGY. Journal of the European Association of Hospital Pharmacists Vol.12 2006/4
Terdapat reseptor apoptotik CD 95 (Fas) di permukaan keratinosit sel T dan NK yg teraktivasi mengekspresikan ligand Fas (FasL) Fas dan FasL berikatan menyebabkan apoptosis pd
keratinosit di epidermis
Pathogenesis• a) type IVa responses, for which T cells produce interferon (IFN)-γ-
activated macrophages, whose typical clinical manifestation is eczema; b) type IVb responses, mediated by T cells producing type 2 helper (TH2) cytokines (interleukin (IL) 4 and IL 5, which in turn induce B cells to produce antibodies and mast cell and eosinophil responses, mainly in DRESS, MPE, and bullous exanthema; c) type IVc responses, induced by CD4+ and CD8+ T cells, which produce cytotoxic mediators that result in keratinocyte apoptosis in MPE and massive apoptosis in TEN; and d) type IVd responses, characterized by neutrophil activation and recruitment induced by T cells via the production of a chemokine, CXCL8, whose typical clinical manifestation
Patogenesis SJS-TEN di Okular Aktivasi Fas-FasL di keratinosit + Reaktif limfosit T sitotoksik menginduksi CD4+CD25+ sel T memproduksi cytotoxic mediators, perforin and
granzyme B
Lisis dan apoptosis keratinosit
Terjadi pemisahan dermis dan epidermis
widespread cell death and necrosis in the deep epidermal layers
Dapat diikuti proses infeksi sekunder
Manifestasi pada mata : konjungtivitis kataralis, blefarokonjungtivitis, iritis, iridosiklitis, kelopak mata edema dan sulit dibuka
Diikuti proses inflamasi pada bulbar and palpebral conjunctiva, but can also involve the cornea, lid margins, eyelashes andeyelid skin
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