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Case Reports
. 2025 Jun 5;17(6):e85396.
doi: 10.7759/cureus.85396. eCollection 2025 Jun.

Survival Following Steroid-Based Therapy in a Case of Penicillin-Induced Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Overlap

Virgilio Blandon  1 , Miguel Borge  1
Affiliations
Case Reports

Survival Following Steroid-Based Therapy in a Case of Penicillin-Induced Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Overlap

Virgilio Blandon et al. Cureus. .

Abstract

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening mucocutaneous reactions with mortality rates strongly correlated with disease severity. We report the case of a 47-year-old Mestizo man in Nicaragua with penicillin-induced SJS/TEN overlap syndrome (body surface area involvement: 10%-30%, score of toxic epidermal necrolysis, SCORTEN: 4, and predicted mortality: 58%). The patient developed mucosal erosions, hemorrhagic crusting, and disseminated erythematous plaques following exposure to amoxicillin and dicloxacillin (penicillin-class antibiotics). Initial misdiagnoses delayed care, but hospitalization prompted early intravenous dexamethasone, fluid resuscitation, topical corticosteroids, and immediate discontinuation of the offending agents. Epidermal detachment halted within 72 hours, with complete reepithelialization by day 10. Transient hyperglycemia resolved spontaneously, and the patient survived without infections or sequelae, contrasting with the SCORTEN-predicted mortality. This outcome supports early immunomodulation to mitigate cytokine-driven necroptosis, challenging historical concerns about corticosteroid risks. Limitations include the single-case design, absence of histopathology, and lack of human leukocyte antigen allele screening for pharmacogenomic insights. The case underscores the efficacy of prompt corticosteroids in high-risk SJS/TEN linked to penicillin-class drugs, emphasizing drug-specific vigilance and discontinuation. It highlights the need for population-specific SCORTEN calibration, pharmacogenomic integration, and publication of rare cases to enhance regional epidemiological understanding.

Keywords: dexamethasone; drug eruptions; drug hypersensitivity; glucocorticoids; immunomodulation; penicillin; scorten; stevens-johnson syndrome; stevens-johnson syndrome/toxic epidermal necrolysis overlap; toxic epidermal necrolysis.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Mucosal involvement in SJS/TEN
Erythema and erosions are observed on the oral mucosa with serohemorrhagic crusting on the red border of the lips SJS: Stevens-Johnson syndrome; TEN: toxic epidermal necrolysis
Figure 2
Figure 2. Erythematous macules, some isolated on the upper back, which are confluent, and small blisters are evident on their surface
Figure 3
Figure 3. Erythematous macules, some isolated, affecting parts of both buttocks, are confluent and present small blisters on their surface
Figure 4
Figure 4. Mucosal involvement in SJS/TEN, where erosions are observed in the genital mucosa, affecting the scrotum and penis
SJS: Stevens-Johnson syndrome; TEN: toxic epidermal necrolysis
Figure 5
Figure 5. Chest X-ray
Posteroanterior projection. In the lower left region, there is a reinforcement of the vascular network and an increase in density suggestive of interstitial infiltrates. The radiologist ruled out pneumonia; findings likely reflect noninfectious pulmonary changes related to Stevens-Johnson syndrome/toxic epidermal necrolysis overlap
Figure 6
Figure 6. Oral mucosa (lips), where no erythematous lesions are evident
Figure 7
Figure 7. Back region showing no evident erythematous lesions
Figure 8
Figure 8. Genital region showing no evident erythematous lesions
See this image and copyright information in PMC

References

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