Cefotaxime-induced Stevens–Johnson syndrome: a case report
Keywords:Cefotaxime, Stevens-Johnson syndrome, Toxic epidermal necrolysis, Hypersensitivity, Medical emergency, Macula-papular lesions, Ulcers, Conjunctivitis, Naranjo’s causality scale, Possible
Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis are two forms of a life-threatening skin condition, in which cell death causes the epidermis to separate from the dermis. The syndrome is thought to be a hypersensitivity complex that affects the skin and the mucous membranes. The most well-known causes are certain medications, but it can also be due to infections, or more rarely, cancers. SJS usually begins with fever, sore throat, and fatigue, which is commonly misdiagnosed and therefore treated with antimicrobials. Ulcers and other lesions begin to appear in the mucous membranes, almost always in the mouth and lips, but also in the genital and anal regions. Conjunctivitis of the eyes occurs in about 30% of children who develop SJS. A rash of round lesions about an inch across arises on the face, trunk, arms and legs, and soles of the feet, but usually not the scalp. SJS is a medical emergency that usually requires hospitalization. Treatment focuses on eliminating the underlying cause, controlling symptoms and minimizing complications. Recovery after SJS can take weeks to months, depending on the severity of the condition. If it was caused by a medication, then the medication and others closely related to it has to be avoided permanently.An 18-month-old male child was admitted to a private health setup in Kolar with the complaints of peeling and discoloration of the skin, ulcerations in the oral cavity, eyelids, and genitalia. The parents gave the history of cefotaxime injection being administered to the child for treating typhoid 20 days back. Seven days after the administration of cefotaxime, the child had developed maculo-papular lesions all over the body. Later on there was peeling and discoloration of the skin. Itching was present. Ulcerations in the oral cavity, eyelids and genitalia were also noticed by the parents, who then brought the child to the health care center. According to the Naranjo’s adverse drug reaction probability scale, there is a possible relation between this adverse drug reaction (SJS) and cefotaxime.
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