Asia Pac Allergy.  2016 Jan;6(1):70-73. 10.5415/apallergy.2016.6.1.70.

Ibuprofen induced Stevens-Johnson syndrome - toxic epidermal necrolysis in Nepal

• Angadi SS
• Karn A

• KMID: 2396973
• DOI: http://doi.org/10.5415/apallergy.2016.6.1.70

Abstract

Despite the fact that any drug can be an impending cause of hypersensitivity reactions, Ibuprofen, an over-the-counter drug used extensively as an analgesic and antipyretic in Asia, is considered to be relatively safe. But herein we report a rare extremely 'rapid onset' occurrence of a severe case of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in a 22-year-old male, induced by 3 doses of 400 mg of Ibuprofen taken at 8-hour interval for eye pain, probably the first case report of rapid onset of TEN by nonsteroidal antiinflammatory drugs in Nepal. SJS and TEN are idiosyncratic, delayed hypersensitivity inflammatory adverse drug reactions that are severe adverse cutaneous drug reactions which predominantly involve the skin and mucous membranes and are linked with high morbidity and mortality. Nevertheless, removal of ibuprofen and its metabolites with plasma exchange and treatment with antibiotics and intravenous corticosteroids along with supportive therapy improved the course of the disorder. This rare case report addresses the fact that severe hypersensitivity reactions can occur with Ibuprofen, which can be potentially dangerous and life threatening. It is thus important for the clinicians to be alert to such severe hypersensitivity reactions even with drugs which are deemed to be probably safe.

Keyword

Hypersensitivity; Ibuprofen; Immune System Diseases; Stevens-Johnson Syndrome

MeSH Terms

Adrenal Cortex Hormones
Anti-Bacterial Agents
Asia
Drug-Related Side Effects and Adverse Reactions
Eye Pain
Humans
Hypersensitivity
Hypersensitivity, Delayed
Ibuprofen*
Immune System Diseases
Male
Mortality
Mucous Membrane
Nepal*
Plasma Exchange
Skin
Stevens-Johnson Syndrome*
Young Adult
Adrenal Cortex Hormones
Anti-Bacterial Agents
Ibuprofen

Figure

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  Fig. 1 Generalised erythematous macules on the trunk with few large confluent flaccid blisters and areas of full detachment.

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  Fig. 2 Large confluent areas of full detachment of epidermis over heels.

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  Fig. 3 The patient with nasogastric tube and extensive sloughing off of epidermis of the face.

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