SCORTEN in Contrast: Two Cases of SJS/TEN Overlap With Divergent Outcomes Highlighting the Role of Renal Dysfunction

Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) overlap is a rare, life-threatening mucocutaneous reaction typically induced by medications. Reports from Central America remain scarce. We present two contrasting cases of SJS/TEN overlap from Nicaragua. Case 1 involved a previously healthy 18-year-old male who developed SJS/TEN overlap with 20% total body surface area (TBSA) involvement following exposure to amoxicillin, diclofenac, and levofloxacin. His SCORTEN score was 1 (estimated mortality < 10%). He received systemic corticosteroids and achieved complete recovery with no sequelae. Case 2 involved a 32-year-old female with stage G5 chronic kidney disease (CKD) not on dialysis who developed SJS/TEN overlap with 30% TBSA involvement after metamizole and acetaminophen exposure. Her SCORTEN score was 2 (estimated mortality ~12%). Despite initial cutaneous improvement with corticosteroids, she developed progressive uremia, refused renal replacement therapy, and ultimately died from multiorgan failure on day 28. These cases illustrate that SCORTEN may have limited ability to capture late mortality driven by pre-existing renal dysfunction and systemic complications. Furthermore, they suggest that cutaneous improvement with corticosteroids does not necessarily translate into survival when underlying organ vulnerability exists. Individualized clinical assessment beyond prognostic scores remains essential, particularly in resource-limited settings.