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Year : 1981  |  Volume : 29  |  Issue : 2  |  Page : 101-103

Stevens Jhonson Syndrome due to Diamox

Department of Ophthalmology, Dayanand Medical College and Hospital, Ludhiana, India

Correspondence Address:
R N Sud
Department of Ophthalmology, Dayanand Medical College and Hospital, Ludhiana
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Source of Support: None, Conflict of Interest: None

PMID: 7327685

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How to cite this article:
Sud R N, Grewal S S. Stevens Jhonson Syndrome due to Diamox. Indian J Ophthalmol 1981;29:101-3

How to cite this URL:
Sud R N, Grewal S S. Stevens Jhonson Syndrome due to Diamox. Indian J Ophthalmol [serial online] 1981 [cited 2024 Feb 26];29:101-3. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?1981/29/2/101/30973

Table 1

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Table 1

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Fig 3

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Fig 3

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Stevens-Jhonson syndrome is characterised by an eruption consisting of sharply defined erythematous patches, associated with an oedematous exudate distributed symmetrically on the hands, forearms and the back of neck and spreading sometimes to the face and calves and mucous membranes. Some of the vesicles may become haemorrhagic. The skin lesions resolve usually without trace. All the mucous membranes may be involved, the conjunctiva, however, getting affected most frequently and disastrously in severe types of the disease. Although the patient may be very seriously ill at the time, the general course of the disease is benign. Various agents such as infections drugs and sera can produce the disease. Most common drugs involved in an allergic reaction of this type are sulphonamides, sulphones, PAS, penicillin, barbiturates, phenylbutazone, bromides, iodides, coal tar derivatives etc.[2],[3]

Acetazolamide (Diamox) is rapidly absor­bed from gastrointestinal tract, is highly bound to plasma proteins and is eliminated unchanged in the urine. Adverse effects are minimal when it is employed in moderate dosage for limited periods. Drowziness and paraesthe­sias may occur at high doses and during pro­longed medication. Skin rash and other allergic reactions are not common. Serious toxic reactions are infrequent. In hepatic cirrhosis, episodes of disorientation may be induced. Hypersensitivity reactions are rela­tively rare. They consist of fever, skin reac­tions, bone marrow depressions, and sulfona­midelike renal lesions. Acetazolamide depre­sses the uptake of iodine by the thyroid gland. Teratogenic effects have been demonstrated in animals and it is recommended that these drugs not be administered during pregnancy. We could not find in the literature the toxi­city leading to Stevens Johnsons. syndrome due to diamox. Since we have came across such cases we are reporting these.

  Case reports Top

We have come across of cases of Stevens Jhonson syndrome due to diamox [Table - 1]. The recovery was followed by stoppage of the drug and putting the patients on systemic corticosteroids.

  Discussion Top

Actazolamide (Diamox) is one of the intra­ocular tension lowering agents, widely emplo­yed to control the same in glaucoma cases.

It acts by inhibiting carbonic anydrase enzyme. It is rapidly absorbed from gastro-intestinal tract, is highly bound to plasma proteins and is eliminated unchanged in the urine. Adverse effects are minimal. Some patients may com­plain of paraesthesias bit serious toxic reac­tions are rare. The authors had never seen before any case of serious toxicity to diamox.

In the present study we saw 8 cases of Stevens-Jhonson Syndrome following intake of diamox and to the best of our knowledge this is the first report of its kind.

Age of the patients varied from 40 to 82 years. There were 5 males and 3 females. The number of tablets consumed before toxicity appeared, varied from as little as 8 tablets to as many as 90 tablets. Interestingly one patient (case 6) had been taking diamox for past 20 years, without any toxic reaction whatsoever. Time taken to recover from the toxic reaction ranged from 5 to 14 days.

Clinical manifestations of Stevens Jhonson Syndrome were fully developed in all the cases except case -5 where it was mild in nature.

In five of the patients, the batch of Diamox was the same (358), while in rest 3 it was not known.

Since no serious toxic reactions had ever been noticed by us ever before and nor had we read any reports of the same, we presumed that it was a particular batch of the drug (358, in 5 of our cases) which was at fault. It may be possible that this particular batch contained some impurity or impurities, or it was some other salt which was being given a trial by the drug manufacturing concern. This is supported by the fact that one of our patients (case 6) had been taking diamox for last 20 years without any side effects whatso­ever, and developed severe reaction when he consumed tablets of this particular defective batch. Also we had been prescribing this drug for the past so many years, but had never seen any serious toxic reaction. nor had we read any report of it before.

  Summary Top

8 cases of Stevens-Jhonson Syndrome as a result of diamox toxicity, 5 males and 3 females are reported. Number of diamox tablets consumed before toxicity appeared varied from 8 to 90, while one patient had been taking the drug for past 20 years. All patients recovered after stoppage of the drug and administration of oral steroids. The time taken for recovery varied from 5 to 14 days.

  References Top

Goodman, Louis; and Gilman, Alfred; 1980. The Pharmacological Basis of Therapeutics, Mac­millan Publishing Co., Inc., New York. p. 498.  Back to cited text no. 1
Sneddon, I.B., and Church, R.E., 1971, Practi­cal Dermatology, Edward Arnold Publishers) Ltd. London. P. 110.  Back to cited text no. 2
Duke-elder, S., 1965, System of Ophthalmology, Vol. VIII, Henry Himpton, London. P. 517.  Back to cited text no. 3


  [Figure - 1], [Figure - 2]

  [Table - 1], [Table - 2]

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