Oral manifestations of herbal medicine induced Steven Johnson syndrome in 3 Nigerian paediatric patients: case report

Abstract

Steven-Johnson syndrome (SJS) is a rare medical emergency that is characterized by widespread skin and mucosal lesions. Oral mucosal involvement is seen in 90% of SJS and it is often widespread and confluent. In the majority of the cases, the symptoms are associated with an adverse drug reaction, usually to non-steroidal anti-inflammatory drugs, sulfonamides, anti-epileptics, or antibiotics. Recently, SJS associated with herbal medicine has been reported. This paper aims to report 3 cases of SJS with marked oral manifestations, following the use of local herbal medicine, diagnosed in a children´s hospital in Nigeria within a year. Three children aged 1.5, 9 and 10 years presented in our emergency unit with features of SJS, history of the use of local herbal medicine to cure an ailment was elicited in all cases before admission into our hospital. All the cases presented with cutaneous exfoliating exanthema and bullous eruptions with oral mucosa appearing as painful crusted erythematous lesions. One of the 3 cases, a male patient, presented clinically with septicaemia complicated with anaemia as well as nasal involvement. Discontinuation of herbal medicine in all cases resulted in a relief of symptoms. A multidisciplinary approach of management was instituted with resultant total recovery of patients. This case report addresses the fact that severe hypersensitivity reactions can occur with the use of herbal medicine. Emphasis should be on active vigilance in the use of herbal medicine.