Pantoprazole-induced Stevens-Johnson Syndrome: A Case-report

Area of Science:

• Dermatology
• Pharmacology
• Toxicology

Background:

• Pantoprazole is a widely prescribed proton pump inhibitor (PPI) for acid-related gastrointestinal disorders.
• Stevens-Johnson syndrome (SJS) is a severe, rare mucocutaneous blistering disease, typically triggered by medications.
• While PPIs are generally well-tolerated, their association with SJS is infrequently reported, with limited literature on pantoprazole-induced cases.

Observation:

• A 49-year-old female presented with a generalized, pruritic eruption and erosive cheilitis after two weeks of self-medicating with pantoprazole.
• Clinical examination revealed targetoid lesions with bullous centers and significant skin detachment (10% body surface area) on the trunk and neck.
• Mucosal involvement included painful, erosive cheilitis with hemorrhagic crusting and nasal cavity erosions.

Findings:

• The patient's symptoms resolved rapidly following pantoprazole withdrawal and topical corticosteroid treatment.
• Extensive investigations excluded infectious causes for the observed dermatological and mucosal reactions.
• The clinical presentation and rapid improvement upon drug cessation strongly suggest a hypersensitivity reaction to pantoprazole.

Implications:

• This case underscores the potential for severe hypersensitivity reactions, including SJS, to pantoprazole, a commonly prescribed PPI.
• Healthcare professionals should maintain a high index of suspicion for SJS in patients presenting with mucocutaneous eruptions after initiating pantoprazole therapy.
• Increased awareness and reporting of such adverse drug reactions are crucial for patient safety and pharmacovigilance concerning widely used medications like PPIs.