Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis in a Pediatric Patient With Dengue Hemorrhagic Fever: A Case Report
Keywords:
SJS, TEN, Viral exanthema, Dengue Hemorrhagic FeverAbstract
Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute, life-threatening mucocutaneous reactions characterised by widespread epidermal necrosis. These conditions are characterised by skin blisters and involvement of the oral, nasal, ocular, and genital mucosa. SJS/TEN are immune-mediated hypersensitivity reactions, most often due to drugs. Infections, including viruses, have also been associated with SJS/TEN. Reactivation of latent viruses can lead to drug eruptions.
Case Illustration: A 4-year-old boy presented with a 4-day history of fever, abdominal and leg pain, followed by diffuse erythematous maculopapular rashes on the face, upper and lower limbs. Laboratory tests showed leukocytosis, thrombocytopenia, and positive dengue IgM and IgG antibody test, leading to an initial diagnosis of Dengue Hemorrhagic Fever with viral exanthema. He was treated with ceftriaxone and metronidazole. Several days later, oral ulcers, conjunctival injection, dark erythematous rashes, and skin desquamation developed. The clinical course prompted a revised diagnosis of SJS.
Discussion: SJS/TEN are acute damage skin conditions and mucosal epithelium as a result of immune-mediated responses. The exact pathogenesis of SJS remains unclear; however, drug exposure is recognized as the primary trigger. In certain cases, SJS may also be induced by viral infections. This case report aims to review current knowledge regarding various aspects of SJS and the potential role of viral infections in drug-induced hypersensitivity reactions.
Conclusion : Based on existing case reports and journals, it cannot be denied that viral infections play a role in the development of SJS/TEN.
References
Menaldi SLS, Bramono K, Indriatmi W. Ilmu penyakit kulit dan kelamin. Jakarta: Badan Penerbit FKUI. 2016;
Hasegawa A, Abe R. Recent advances in managing and understanding Stevens-Johnson syndrome and toxic epidermal necrolysis. F1000Res. 2020 Jun 16;9:612.
Knöpfel N, Noguera-Morel L, Latour I, Torrelo A. Viral exanthems in children: A great imitator. Clin Dermatol. 2019 May;37(3):213–26.
Fetriani U, Zakiawati D. Viral Triggers Exposed: A Systematic Review of Virus-Induced Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis. J Inflamm Res. 2025 Sep;Volume 18:12575–88.
Aparcana-Choque WD, Pisconti-Palacios YM, Cordova-Tello I, Ausejo-Galarza J, Gomez-Gonzales W, Kochubei-Hurtado A, et al. Steven-Jonhson Syndrome in a Patient With Dengue Infection in Peru: A Case Report. J Investig Med High Impact Case Rep. 2024 Jan 28;12.
Saffar MJ, Rahmatpour Rokni G, Raeasian M. Pediatric Viral Exanthema: A Review Article. J Pediatr Rev. 2017 Apr 15;5(2).
Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ. Fitzpatrick’s dermatology in general medicine. McGraw-Hill New York; 2019.
Khuwaja A, Shahab A, Hussain SA. Acetaminophen induced Steven Johnson syndrome-toxic epidermal necrolysis overlap. J Pak Med Assoc. 2012;62(5):524.
Ban GY, Ahn SJ, Yoo HS, Park HS, Ye YM. Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis Associated with Acetaminophen Use during Viral Infections. Immune Netw. 2016;16(4):256.
Anci E, Braun C, Marinosci A, Rodieux F, Midun E, Torres MJ, et al. Viral Infections and Cutaneous Drug-Related Eruptions. Front Pharmacol. 2021 Mar 10;11.
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Copyright (c) 2026 Jeniffer Handiokho, Kartilia Nurani Putri, Prima Kartika Esti, Eka Komarasari (Author)
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