A suspected case of Steven-Johnson Syndrome and toxic epidermal necrolysis overlap due to clindamycin administration – Report of a rare case
- Author:
Eva Marie C. Gamallo
1
;
Derek Leand Tan
1
Author Information
- Publication Type:Case Reports
- Keywords: Steven Johnson Syndrome-Toxic Epidermal Necrolysis Overlap
- MeSH: Clindamycin
- From: Philippine Journal of Internal Medicine 2024;62(2):110-115
- CountryPhilippines
- Language:English
-
Abstract:
Steven Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe cutaneous adverse reactions (SCAR) differentiated by degree of skin detachment. Common triggers include anticonvulsants, sulfonamides, antibiotics (penicillin, cephalosporin, quinolones) and acetaminophen. Reports of clindamycin causing cutaneous complications are rare with only 6 published reports, none of which were reported in the Philippines. Though uncommon, it is an important consideration in patients presenting with erythematous to violaceous purpuric macules that progress to full thickness epidermal exfoliation.
A 59-year-old female who presented with erythematous maculopapular rash on both hands, dry crusted lesions on the mouth and positive Nikolsky sign within 28 days of administration of Clindamycin. Algorithm for assessment of drug causality in SJS and TENS (ALDEN) was done and Clindamycin scored 6 points, which points to a definite drug causality of SJS/TEN.
A female in her late 50s presented with fatigue, malaise, and sore throat. Initially managed as a case of sepsis peritonsillar abscess right but later in the course of admission, presented with erythematous maculopapular rash on both hands and dry crusted lesions on the mouth. Patient was clinically diagnosed with Steven-Johnson syndrome and toxic epidermal syndrome and was given a course of intravenous hydrocortisone. Patient unfortunately expired due to overwhelming sepsis.
Severe cutaneous adverse reaction induced by clindamycin are rare but important life-threatening conditions which needs prompt recognition and treatment. SJS/TEN as a secondary diagnosis leads to a delay in management, therefore a high index of suspicion and the utility of validated scoring tools should be maintained throughout the course of treatment. - Full text:20241101025832232697 2023-232 Case OK.pdf
