Recurrent Stevens-Johnson Syndrome Following Inadvertent Re-exposure to Cotrimoxazole: A Preventable Adverse Drug...

Stevens-Johnson syndrome (SJS) is a severe cutaneous adverse drug reaction characterized by epidermal detachment and mucosal involvement. Cotrimoxazole is a well-known causative agent; however, recurrence following re-exposure remains underreported and preventable. We report a case of a 61-year-old female patient who presented with a burning sensation over the body, accompanied by superficial and crusted erosions over the lips and a few hyperpigmented macules on the chest for 10 days. On examination, a positive Nikolsky sign with <10% body surface area involvement was found, and a diagnosis of SJS was made. Notably, the patient had a documented history of SJS induced by cotrimoxazole five years earlier, with findings highly suggestive of recurrence following inadvertent re-exposure to the same causative agent. The disease severity was assessed using the SCORe of Toxic Epidermal Necrolysis (SCORTEN) criteria. The supportive treatment with dexamethasone, fluconazole, folic acid, and PCV transfusion was given, leading to gradual clinical improvement. This case highlights the importance of thorough drug-reaction history, avoidance of re-exposure to prevent recurrent severe cutaneous adverse reactions.