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Cotrimoxazole Induced Steven Johnson Syndrome: A Case Report
Ayushma Acharya1, Shreedhar Prasad Acharya1, Tulsi Ram Bhattarai2
1Kathmandu Medical College, Sinamagal, Kathmandu, Nepal.
JNMA; Journal of the Nepal Medical Association
|October 17, 2020
Summary
A rare case of Steven Johnson syndrome (SJS) was triggered by cotrimoxazole in a 50-year-old female. Prompt supportive care, including antibiotics and corticosteroids, successfully managed this life-threatening drug reaction.
Area of Science:
- Dermatology
- Pharmacology
- Toxicology
Background:
- Steven Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe adverse drug reactions.
- Commonly associated drugs include antiepileptics, penicillin, and allopurinol.
- Other causes include infections, malignancy, or idiopathic factors.
Observation:
- A 50-year-old female presented with burning sensation and atypical target lesions.
- Lesions coalesced, involving the face, chest, and upper limbs.
- Positive Nikolsky sign and tenderness with <10% body surface area involvement were noted.
Findings:
- The patient was diagnosed with cotrimoxazole-induced Steven Johnson syndrome.
- Management involved ICU admission, supportive care, and prophylactic antibiotics (teicoplanin) and corticosteroids (dexamethasone).
Implications:
- This case highlights the rare occurrence of cotrimoxazole-induced SJS.
- Effective management of SJS/TEN relies on prompt supportive care.
- Broad-spectrum antibiotics and corticosteroids can be crucial in managing these severe cutaneous reactions.
