Abstract
BACKGROUND:
Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, potentially life‑threatening, severe mucocutaneous adverse reactions characterized by extensive epidermal detachment, erosion of mucosae and severe constitutional symptoms. The incidence of SJS varies from 1.2 to 6/million patient-years and that of TEN being 0.4–1.2/million patient-years, with the mortality rate in TEN being three times higher than that of SJS. High-risk drugs for the development of SJS-TEN include phenobarbital, phenytoin, carbamazepine, lamotrigine, nevirapine, nonsteroidal anti-inflammatory drugs, allopurinol, cotrimoxazole and fluconazole.
AIM:
This case outlines the importance of early diagnosis, rapid identification and cessation of the causative drug in addition to supportive care for a better outcome.
CASE DESCRIPTION:
A 40yr old female patient who was operated for right sided cerebropontine angle tumour 1month back presented to OPD with redness and watering of eyes along with oral mucosal erosions and blisters over face and neck since 2days. On further evaluation the lady mentioned that she had taken tab aceclofenac which was prescribed by the local doctor for the complaint of surgical site pain. After that she started developing these lesions. A diagnosis of Steven Johnson syndrome was made based on clinical examination and history and was admitted. Immediately the drug was withdrawn and supportive therapy was started. The lesions progressed into toxic epidermal necrolysis spectrum involving >30% BSA. Prognosis was assessed using SCORTEN. Patient was treated in a multidisciplinary approach. Systemic corticosteroids and cyclosporine were the main stay of treatment along with general measures. Finally the patient was recovered and discharged.
CONCLUSION:
Stevens–Johnson syndrome and toxic epidermal necrolysis are severe, life‑threatening mucocutaneous adverse drug reactions with a high morbidity and mortality. The management essentials include early recognition of the condition, cessation of suspected drug(s), supportive therapy, initiation of specific therapy, management of complications and prevention of future episodes.
