Cotrimoxazole Induced Steven Johnson Syndrome: A Case Report

Abstract

Steven Johnson syndrome and toxic epidermal necrolysis are severe and rare adverse drug reactions usually caused by drugs like antiepileptics, penicillin and allopurinol and sometimes also due to infections, malignancy or idiopathic in some cases. Here we are reporting a case of a 50 years female who came with complaint of a burning sensation on the upper half of the body with atypical flat target lesion that later coalesced involving her face, chest and bilateral upper limbs. On examination, positive nikolsky sign and tenderness with <10% body surface area involvement was noticed. The diagnosis of cotrimoxazole induced Steven Johnson syndrome was made. Patient was shifted to ICU and given supportive care along with prophylactic teicoplanin, itraconazole and dexamethasone. The mechanism of eruptions in our patient was due to cotrimoxazole. Cotrimoxazole induced Steven Johnson syndrome is rare and the supportive management with broad spectrum antibiotic and the corticosteroid was enough to beat this life-threatening condition. Keywords: cotrimoxazole; pneumonia; Steven Johnson syndrome.

Figure 1. Purpuric macules and papules with atypical target on the posterior aspect of trunk.

Figure 2. Hemorrhagic crust with erosion of mucosa of lips.

Figure 3A 3B. Hyperpigmented macules to patches with areas of desquamation after 2 weeks of disease (A), Red to yellow crust with areas of hemorrhage in mucosa of lips with re-epithelization of face (B).