Potential Adverse Effect Steven Johnson Syndrome with Supplemental Berberine Use

Abstract

Steven-Johnson Syndrome is a rare adverse skin reaction, which may progress to critical conditions. The presentation of SJS is a widespread, type-IV hypersensitivity, skin reaction typically induced by infection and numerous medications which occurs approximately 12 hours after exposure to infection or medication. Patients typically initially present with fever, headache, and general malaise. In these patients, within 4 days to 4 weeks [1] of causative medication usage, a diffuse rash develops. Severe cases of SJS can place the patient in critical condition. Complications of SJS can include bacterial infection, excessive fluid loss from denuded skin (or loss of epidermis), hypovolemic shock, or septic shock. [1] Prompt diagnosis and immediate discontinuation of medication is essential to prevent life threatening complications. Herein, we document a case of a patient presenting to the Emergency Department (ED) three days prior to follow up in our office with bilateral leg rash for which the ED prescribed hydrocortisone cream. Upon examination in office, the erythematous eruption had spread to the entire body including her palms. She had started the herbal supplement berberine a month prior to the initial presentation of the rash. Upon cessation of the berberine and completion of a Medrol dose pack, the rash resolved.