THE PRICE OF A PILL: STEVENS-JOHNSON SYNDROME AFTER SELF-MEDICATION OF FLUOROQUINOLONE

Abstract

Stevens-Johnson Syndrome (SJS) is a rare and potentially life-threatening mucocutaneous reaction, usually caused by drugs (such as NSAIDs, antibiotics and antiepileptics). In the described case study, a medical house officer who was 28 years old used moxifloxacin and over-the-counter cough medicine, another cause of acute SJS. The patient had progressive worsening of the symptoms including involvement of mucosa, targetoid skin lesions, odynophagia, oliguria, and systemic signs despite the symptom treatment and multiple courses of antimicrobials. The laboratory work revealed elevated levels of hepatic enzymes, neutrophilic leukocytosis, and various markers of inflammations, which suggests multiorgan involvement. Early SJS was diagnosed based on clinical manifestations and all the drugs suspected to have caused it were discontinued immediately. Following commencement of high-dose intravenous dexamethasone the patient improved rapidly and ultimately discharged with a tapering steroid dose. The case highlights the need to provide clinical focus to prescription and self-medication practices and the intense association of fluoroquinolones and SJS, especially moxifloxacin. Recovery is based on early diagnosis of mucocutaneous symptoms, prompter elimination of the offending substance and immediate beginning of immunomodulatory therapy. The case also illustrates the role that corticosteroids along with other interventions such as TNF- alpha blockers are taking in controlling SJS. In an attempt to minimize the morbidity and mortality associated with such a severe drug reaction, knowledge, diagnostic handling, and antibiotic vigilance rate higher as ways to prevent such reactions.

Keywords: Stevens-Johnson Syndrome, Self medication, Diagnostics.