Reactions 1680, p30 - 2 Dec 2017
Stevens Johnson-syndrome: case report
A 73-year-old woman developed Stevens Johnson syndrome
following treatment with amoxicillin.
The woman was diagnosed with upper gastrointestinal
bleeding and peptic-ulcer in May 2015. She received anti-
Helicobacter pylori treatment with oral amoxicillin [dosage and
duration of treatment to reaction onset not stated],
pantoprazole, clarithromycin and colloidal bismuth pectin.
She presented with an itchy erythema around her neck. On
admission, oedematous erythema was observed on the face,
head and neck. Her eyelids were slightly swollen. She had also
been receiving unspecified anti-hypertensive tablets for
hypertension. Laboratory tests revealed a neutrophil ratio of
74%, eosinophil ratio of 5.2%, ketone greater than 2 mmol/L,
D-dimer 1.23mg/L. Following admission, her rash on the
trunk, neck, limbs and face had worsened and she also
experienced itchiness. She had fever, and the peripheral blood
leucocytes were elevated. The drug eruption area and severity
index (DASI) score was 9.9 points.
The woman received treatment with compound glycyrrhizin
and calamine lotion. However, her rash further integrated and
worsened. The conjunctiva showed hyperaemia and the
conjunctival secretions increased. Her face was swollen. She
presented with fever at 6:00am on day 3 following the
admission. The rash had integrated further with increased
swelling and redness. She had difficulty in opening her eyes,
and the conjunctival secretions increased further. Typical
target-like erythematous papules developed on lower limbs.
On day 4, her condition worsened. The rash aggravated and
covered 80% of the body surface area. Her skin temperature
increased. Her rash became severe. The body temperature
was 39.6°C at 6:00pm. Marked increase in the leucocyte and
neutrophil count was observed. She was diagnosed with
Stevens Johnson syndrome. She then received treatment with
etanercept. The rash and fever were under control. The
conjunctival erosion was almost recovered. Her swelling
decreased and the rash became less itchy. She was discharged
on day 16 following complete recovery. The DASI score at
discharge was 0.4 points.
Author comment: "According to the probability of drug
eruption, amoxicillin allergy was the most probable cause."
"Parts of the rash were target-like and therefore, the diagnosis
was severe erythema multiforme-type drug eruption (Stevens-
Ling X, et al. Severe erythema multiforme-type drug eruption controlled by tumor
necrosis factor-alpha antagonist: A case study. Experimental and Therapeutic
Medicine 14: 5727-5732, No. 6, Dec 2017. Available from: URL: https://
doi.org/10.3892/etm.2017.5336 - China
Reactions 2 Dec 2017 No. 16800114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved