Background::Stevens-Johnson Syndrome (SJS) is an infrequent yet severe mucocutaneous
reaction that involves less than 10% of the Body Surface Area (BSA). It is predominantly
induced by certain medications, including anticonvulsants (e.g., Lamotrigine, Carbamazepine,
Phenytoin, Phenobarbitone), Allopurinol at doses above 100 mg per day, and sulphonamides
(e.g., Cotrimoxazole, Sulfasalazine). Genetic predispositions, particularly the presence of the
HLA-B*1502 allele, significantly increase the risk of developing SJS. This case report discusses
a unique presentation of SJS in a young female patient, emphasizing the critical need for genetic
screening and careful monitoring when prescribing Carbamazepine, especially in populations at
higher genetic risk.
Case Presentation::A 19-year-old female patient, who had been on Phenytoin and Sodium
Valproate for epilepsy management over the past year, was newly prescribed Carbamazepine.
Within a week of initiating Carbamazepine, the patient experienced a seizure, followed by the
sudden onset of fever, painful sores, and blisters covering the upper body, along with mucous
discharge from both eyes. These symptoms rapidly worsened. Based on clinical presentations
and the extent of epidermal detachment, the patient was diagnosed with SJS. The severity and
mortality risks were assessed using the SCORTEN score. Therapeutic interventions included intravenous
Ranitidine, Ondansetron, Paracetamol, Midazolam, Levetiracetam, and Dexamethasone,
along with oral Fluconazole, Chlorpheniramine tablets, and Ciprofloxacin eye drops.
The patient showed significant improvement and was discharged after fourteen days with followup
advice.
Conclusion::This case underscores the critical importance of performing genetic testing for the
HLA-B*1502 allele and conducting baseline blood tests before initiating Carbamazepine therapy.
Such precautionary measures can significantly mitigate the risk of severe adverse reactions
like SJS. This report adds to the scientific literature by highlighting the potential dangers associated
with anticonvulsant therapies and the necessity for personalized medicine approaches in
preventing life-threatening conditions. The main takeaway is the pivotal role of genetic screening
and vigilant monitoring in the management of patients requiring anticonvulsant medications to
prevent serious adverse reactions.