Abstract
Steven Johnson syndrome and toxic epidermal necrolysis are severe and rare adverse drug reactions usually caused by drugs like antiepileptics, penicillin and allopurinol and sometimes also due to infections, malignancy or idiopathic in some cases. Here we are reporting a case of a 50 years female who came with complaint of a burning sensation on the upper half of the body with atypical flat target lesion that later coalesced involving her face, chest and bilateral upper limbs. On examination, positive nikolsky sign and tenderness with <10% body surface area involvement was noticed. The diagnosis of cotrimoxazole induced Steven Johnson syndrome was made. Patient was shifted to ICU and given supportive care along with prophylactic teicoplanin, itraconazole and dexamethasone. The mechanism of eruptions in our patient was due to cotrimoxazole. Cotrimoxazole induced Steven Johnson syndrome is rare and the supportive management with broad spectrum antibiotic and the corticosteroid was enough to beat this life-threatening condition. Keywords: cotrimoxazole; pneumonia; Steven Johnson syndrome.
Highlights
Steven Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are considered as a single spectrum of disease, characterized by detachment of dead epidermis and erosion of mucous membrane along with a positive Nikolsky sign.1 It is a type 4 hypersensitivity reaction with release of various cytotoxic signals activated by cytotoxic T lymphocytes and natural killer cells.2 SJS and TEN are separated based on body surface area with Steven Johnson syndrome having 30% involvement.1 A study by Yang et al had reported that the incidence of SJS and TEN to be 1.0 to 6.0 per million and 0.4 to 1.2 per million, respectively but this is 2 fold for the Asian population.2 uncommon they are associated with high mortality.3A 50-year-old female came to our hospital with a chief complaint of burning sensation over the upper half of her body with development of atypical reddish-purple target macules and papules over her chest, neck and face since 1 day
Steven Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are separated based on body surface area with Steven Johnson syndrome having 30% involvement
Patient was under cotrimoxazole for 2 weeks due to a history of unresolving pneumonia and recent wound excision procedure 2 months back
Summary
Steven Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are considered as a single spectrum of disease, characterized by detachment of dead epidermis and erosion of mucous membrane along with a positive Nikolsky sign.1 It is a type 4 hypersensitivity reaction with release of various cytotoxic signals activated by cytotoxic T lymphocytes and natural killer cells.2 SJS and TEN are separated based on body surface area with Steven Johnson syndrome having 30% involvement.1 A study by Yang et al had reported that the incidence of SJS and TEN to be 1.0 to 6.0 per million and 0.4 to 1.2 per million, respectively but this is 2 fold for the Asian population.2 uncommon they are associated with high mortality.3A 50-year-old female came to our hospital with a chief complaint of burning sensation over the upper half of her body with development of atypical reddish-purple target macules and papules over her chest, neck and face since 1 day. The lesions appeared in the lips early the following morning with patient having symptoms of difficulty in swallowing and watering of eyes. Patient was under cotrimoxazole for 2 weeks due to a history of unresolving pneumonia and recent wound excision procedure 2 months back.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
