Liu WY, Zhang JR, Xu XM, Ye TY. Toxic epidermal necrolysis induced by ritodrine in pregnancy: A case report. World J Clin Cases 2022; 10(4): 1381-1387 [PMID: 35211573 DOI: 10.12998/wjcc.v10.i4.1381]
Corresponding Author of This Article
Tian-Yi Ye, MD, Doctor, Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 650 Xinsongjiang Road, Songjiang District, Shanghai 201600, China. yty1119@sina.com
Research Domain of This Article
Obstetrics & Gynecology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Feb 6, 2022; 10(4): 1381-1387 Published online Feb 6, 2022. doi: 10.12998/wjcc.v10.i4.1381
Toxic epidermal necrolysis induced by ritodrine in pregnancy: A case report
Wen-Yu Liu, Jia-Rong Zhang, Xian-Ming Xu, Tian-Yi Ye
Wen-Yu Liu, Xian-Ming Xu, Tian-Yi Ye, Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201600, China
Jia-Rong Zhang, Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Author contributions: Liu WY and Ye TY collected the patient data, contributed to conception of the manuscript, reviewed the literature, and wrote the paper; the surgery was performed by Xu XM and Zhang JR; Xu XM and Zhang JR were responsible for the revision of the manuscript for important intellectual content; all authors read and approved the final manuscript.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tian-Yi Ye, MD, Doctor, Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 650 Xinsongjiang Road, Songjiang District, Shanghai 201600, China. yty1119@sina.com
Received: September 3, 2021 Peer-review started: September 3, 2021 First decision: November 11, 2021 Revised: November 21, 2021 Accepted: December 25, 2021 Article in press: December 25, 2021 Published online: February 6, 2022 Processing time: 142 Days and 17.9 Hours
Abstract
BACKGROUND
Preterm birth accounts for about 12% of all pregnancies worldwide and is the leading cause of neonatal morbidity and mortality. In order to avoid premature birth and prolong gestational age, tocolytics are the first and the best choice. Ritodrine is the most commonly used tocolytic medication. However, side effects such as pulmonary edema, hypokalemia, and hyperglycemia are known. Here we report a rare but serious side effect–toxic epidermal necrolysis (TEN)–caused by ritodrine.
CASE SUMMARY
A woman (31 years, gravida 4, para 2) was hospitalized because of premature contractions at 27 + 6 wk of gestation. A skin rash with pruritus appeared at 32 + 3 wk of gestation after administration of ritodrine, indomethacin, and dexamethasone, and it spread throughout the whole body in 3 d, particularly the four limbs. After 11 d’ treatment, she was diagnosed with TEN. An emergency cesarean section was performed immediately to deliver the baby and intensive symptomatic treatment was promptly commenced after delivery. She recovered from the severe condition without any sequelae except for slight pigmentation after symptomatic treatment.
CONCLUSION
When a skin rash appears during the administration of ritodrine, we are supposed to consider the risk of TEN.
Core Tip: Toxic epidermal necrolysis (TEN) is a rare life-threatening cutaneous drug reaction, which may be a threat to the mother and the fetus during pregnancy. In our case, the patient’s condition began to improve when the ritodrine was stopped. So ritodrine hydrochloride could be a cause of TEN. If a rash occurs during the use of ritodrine, it is urgent for doctors to consider the side-effect of the drug and to stop its use immediately. The use of tocolytic agents should be individualized and depend on potential adverse events and maternal condition.
