Dipyrone (Metamizole)-Induced Stevens-Johnson Syndrome

Abstract

Stevens-Johnson Syndrome (SJS), a severe mucocutaneous hypersensitivity reaction primarily triggered by drugs, poses a low-incidence, high-mortality challenge. This report explores its clinical nuances and emphasizes supportive care as the mainstay of treatment. A 74-year-old female, burdened with a complex medical history, presented with a non-pruritic macular rash escalating to skin and oral mucosal involvement. A recent introduction of dipyrone (metamizole) implicated drug-induced SJS. Histopathological confirmation guided treatment involving supportive care, corticosteroids, and wound care, resulting in clinical improvement. The case underscores the significance of histopathological confirmation and thorough medication history in navigating SJS complexities, especially in patients with comorbidities like connective tissue disease. A successful multidisciplinary approach and the decision for post-discharge monitoring highlight the intricate management challenges. This case illuminates the intricate interplay of medication-induced hypersensitivity, comorbidities, and management challenges in SJS. Optimal outcomes require prompt diagnosis, trigger identification, and a multidisciplinary treatment approach, emphasizing ongoing research and clinical vigilance.

Keywords: adverse reactions; drug-induced allergic response; metamizole; rare skin disease; stevens-johnson-syndrome.

Figure 1. Dorsal surface of the patient's right hand showing desquamative lesions.

Figure 2. Histopathology of the patient's skin biopsy (H&E stain). There is evidence of necrosis of keratinocytes in the epidermis and lymphocyte infiltrates in the papillary dermis (arrows).