Concomitant Nicolau’s and Stevens-Johnson syndrome—Toxic epidermal necrolysis overlap after diphtheria, pertussis, tetanus vaccination: An unusual presentation in a young child

Abstract

Diphtheria, pertussis, tetanus (DPT) is a live attenuated vaccine included in the national immunization schedule. Common adverse effects of this vaccine include localized pain, erythema, and high-grade fever. Rarely, it can cause severe localized or generalized reactions such as Nicolau’s syndrome (NS), erythema multiforme (EM), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). A 6-year-old boy developed severe pain over left gluteal region, immediately after DPT vaccine, followed by local ulceration. Two days later, he also developed mucocutaneous lesions. Clinical features were consistent with NS and SJS-TEN overlap. Concomitant NS with SJS-TEN overlap after DPT vaccine is rare and has not been reported earlier.