Ciprofloxacin-Associated Stevens-Johnson Syndrome in A Healthy Young Woman: A Case Report
Keywords:
Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis, Ciprofloxacin, Drug-induced skin reaction, SCORTENAbstract
Background: Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare but life-threatening mucocutaneous reactions, primarily triggered by medications. These conditions are characterized by extensive epidermal necrosis, mucosal involvement, and systemic complications. Ciprofloxacin, a fluoroquinolone antibiotic, is an uncommon but recognized cause of SJS. Early recognition and multidisciplinary management are crucial in reducing morbidity and mortality. Case Presentation: We report a case of a previously healthy 23-year-old woman who developed SJS following ciprofloxacin use. The patient presented with widespread erythematous patches, blistering lesions, mucosal erosions, ocular involvement, and urogenital ulcerations. The SCORTEN score was calculated to be 2, indicating an estimated mortality risk of 12.1%. Management included immediate discontinuation of the suspected causative drug, systemic corticosteroids, wound care, fluid and electrolyte balance maintenance, and supportive ophthalmologic and urologic treatments. The patient demonstrated clinical improvement and was discharged after a 11-day hospital stay. Conclusion: This case highlights the potential for ciprofloxacin to induce SJS, emphasizing the need for vigilance in drug-induced cutaneous reactions, even in younger patients. Prompt diagnosis, drug withdrawal, and comprehensive supportive care play pivotal roles in patient outcomes. Given the unpredictability of long-term sequelae, continued monitoring is essential.References
Frantz R, Huang S, Are A, Motaparthi K. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Review of Diagnosis and Management. Medicina (Kaunas). 2021 Aug 28;57(9):895. doi: 10.3390/medicina57090895. PMID: 34577817; PMCID: PMC8472007.
Isaac WA, Damayanti D, Fatimah N, Hidayati AN. The profiles of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) patients in tertiary hospital. Berk Ilmu Kesehat Kulit dan Kelamin. 2021;33(2):116-22.
Faraji N, Goli R, Mohsennezhad P, Mohammadpour Y, Parizad N, Salamat E, Pourbahram R, Bazbandi S. NSAID (nonsteroidal anti-inflammatory drugs) Induced Stevens Johnson Syndrome in a 50-year-old woman: A case study. Toxicol Rep. 2024 Feb 28;12:289-291. doi: 10.1016/j.toxrep.2024.02.006. PMID: 38469333; PMCID: PMC10925921.
Sudarsa PS, Puspawati NM, Purnama NK, Sanjaya IG, Hamid AR. Toxic Epidermal Necrolysis (TEN) in an elderly with comorbidities: a case report. Bali Medical Journal. 2020 Apr 1;9(1):323-6.
Shrestha AB, Shrestha S, Yadav PK, Adhikari L, Yadav A. Cefixime induced Steven Johnson syndrome: A case report from Bangladesh. Ann Med Surg (Lond). 2022 Jun 28;79:104089. doi: 10.1016/j.amsu.2022.104089. PMID: 35860067; PMCID: PMC9289488.
Skafida E, Giannas R. Stevens-Johnson Syndrome in a Patient With Recent SARS-CoV-2 Infection and Ciprofloxacin Administration. Cureus. 2023 Sep 12;15(9):e45099. doi: 10.7759/cureus.45099. PMID: 37842491; PMCID: PMC10569151.
Wisan AB, Aviana F. Dermatosis Mengancam Jiwa: Sindrom Stevens-Johnson Diduga Akibat Methampyron. Cermin Dunia Kedokteran. 2022 Aug 1;49(8):443-6.
Hsieh PP, Nurmawatin N, Khalisah N, Nurjannah N, Tantu OI, Pikatan O, Diana PZ. Sindroma Steven–Johnson terinduksi carbamazepine: laporan kasus. Intisari Sains Medis. 2021 Dec 30;12(3):948-51.
Hasegawa A, Abe R. Recent advances in managing and understanding Stevens-Johnson syndrome and toxic epidermal necrolysis. F1000Res. 2020 Jun 16;9:F1000 Faculty Rev-612. doi: 10.12688/f1000research.24748.1. PMID: 32595945; PMCID: PMC7308994.
Pratama HA, Sofyan A, Munir MA. SINDROM STEVEN JOHNSON: LAPORAN KASUS. Jurnal Medical Profession (Medpro). 2023 May 24;5(1):1-7.
Lee EY, Knox C, Phillips EJ. Worldwide Prevalence of Antibiotic-Associated Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Systematic Review and Meta-analysis. JAMA Dermatol. 2023 Apr 1;159(4):384-392. doi: 10.1001/jamadermatol.2022.6378. PMID: 36790777; PMCID: PMC9932945.
Diana R, Irawanto ME. Patofisiologi dan Manajemen Terapi Sindrom Stevens-Johnson (SJS) dan Nekrolisis Epidermal Toksik (NET). MEDICINUS. 2020;33(2):50-62.
Memon S, Ahmed N, Nasir Memon M, Zahoor F, Afzal G. Linezolid and Ciprofloxacin-Induced SJS/TEN (Stevens-Johnson Syndrome/Toxic Epidermolysis Necrosis) Overlap in a Patient With Borderline Personality Disorder During a Single Hospital Stay: A Difficult Case to Manage. Cureus. 2023 May 19;15(5):e39242. doi: 10.7759/cureus.39242. PMID: 37342736; PMCID: PMC10277191.
Yalıcı-Armağan B, Demircan C, Akdoğan N, Gülseren D, Doğan-Günaydın S, Elçin G, Karaduman A, Atakan ZN, Ersoy-Evans S. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Retrospective Analysis of 23 Patients. Acta Medica. 2021 Sep 20;52(3):239-43.
Al Rajaibi R, Al Rumhi T, Al Abri AM. Carbamazepine-Induced Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Overlap Treated Successfully with Oral Cyclosporin: Case report and literature review. Sultan Qaboos Univ Med J. 2021 Aug;21(3):491-494. doi: 10.18295/squmj.4.2021.002. Epub 2021 Aug 29. PMID: 34522420; PMCID: PMC8407905.
Koh HK, Chai ZT, Tay HW, et al. Risk factors and diagnostic markers of bacteremia in Stevens-Johnson syndrome and toxic epidermal necrolysis: A cohort study of 176 patients. J Am Acad Dermatol 2019; 81:686.
O'Brien KF, Bradley SE, Mitchell CM, Cardis MA, Mauskar MM, Pasieka HB. Vulvovaginal manifestations in Stevens-Johnson syndrome and toxic epidermal necrolysis: Prevention and treatment. J Am Acad Dermatol. 2021 Aug;85(2):523-528. doi: 10.1016/j.jaad.2019.08.031. Epub 2019 Aug 19. PMID: 31437544.
Zimmerman D, Dang NH. Stevens–Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN): Immunologic Reactions. Oncologic Critical Care. 2019 Jul 9:267–80. doi: 10.1007/978-3-319-74588-6_195. PMCID: PMC7122590.
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