Delayed Stevens-Johnson syndrome induced by combined administration of carbamazepine and botulinum toxin: A case...

Steven-Johnson syndrome (SJS) is characterized by severe illness, rapid progression, and high mortality rates, with the vast majority of cases induced by medications. Botulinum toxin, a neurotoxin produced by Clostridium botulinum, has not been reported in the literature as a causative agent of SJS.

A 56-year-old male patient, who underwent surgery for cerebral hemorrhage, developed widespread patchy annular papules following the injection of botulinum toxin into the masseter muscle. Some lesions exhibited a target-like appearance, and all major organ systems were affected.

Consider the delayed SJS induced by the combination of carbamazepine and botulinum toxin.

Intravenous administration of methylprednisolone in conjunction with immunoglobulin is indicated. For ocular lesions, topical treatment includes tobramycin-dexamethasone and sodium hyaluronate eye drops; for ulcerated areas, local application of lactulose-iodoquinol is recommended, while non-ulcerated regions should be treated with halometasone ointment topically.

The patient has been discharged, and there has been a noticeable improvement in their symptoms.

In order to prevent severe adverse reactions, patients using carbamazepine in conjunction with other medications should be vigilant for the early symptoms of serious drug rashes.