A Case Study of Oxcarbazepine-induced Stevens-johnson Syndrome

Abstract

Background:  Stevens–Johnson syndrome is a rare potentially fatal disorder characterized by mucosal membrane erosions, bullous skin lesions and epidermal detachment. Objective: This case report discusses a case of a patient who developed seizures and macular rashes as a result of Stevens–Johnson syndrome induced by oxcarbazepine. Case presentation: An eight-year-old girl was admitted to hospital with complaints of seizure episodes that occurred during sleep, characterized by drooling, jerky stiff upper limbs, throat sounds, and blue lips. Patient was born with severe intrauterine growth retardation and microcephaly and was diagnosed with congenital cytomegalovirus (CMV). EEG results confirmed that focal epilepsy was the underlying cause of seizures. The patient was given oxcarbazepine as an anticonvulsant medication after confirming epilepsy diagnosis.  However, after two weeks of treatment, patient developed rashes and skin lesions all over her body except hands. These skin lesions and rashes were red and tan in color, swollen, itchy, scaly, dry, popular, macular and patchy. The skin detachment was less than 10% of BSA (body surface area). The Naranjo algorithm was used to check the probability of a drug reaction and through the WHO-UMC criteria for causality, it was decided that oxcarbazepine induced the syndrome. Hence, patient was diagnosed as a case of Stevens-Johnson syndrome. Conclusion:Stevens–Johnson syndrome is a rare condition that can cause rashes and epidermal detachment. It can be caused by adverse effects of medications; however, exact pathogenesis is unknown. Therefore, studies on large number of patients are required to understand the pathogenesis of oxcarbazepine-induced SJS.