Woman gets painful rashes, scales after ibuprofen dose. What is the Stevens-Johnson Syndrome?

Stevens-Johnson Syndrome is characterised by painful, blistering rashes that spread rapidly. (Image: nhs.uk)

A woman in Iraq was rushed to the hospital with flu-like symptoms after a single 800mg dose of ibuprofen, an anti-inflammatory drug. The 45-year-old developed a rash and scales on her face and limbs and a yellow discharge started oozing out from her eyes. In addition to these, she got a swollen face, red eyes and crusted, yellow lips – all within four hours of her ingesting the medicine.

Doctors diagnosed her with Stevens-Johnson Syndrome – a deadly skin disorder triggered by medicines like antibiotics – after several tests, X-rays and biopsies.

What is the Stevens-Johnson Syndrome?

Stevens-Johnson Syndrome (SJS) is a rare yet severe disorder of the skin and mucous membranes, characterised by a hypersensitivity reaction.

The onset of Stevens-Johnson Syndrome is often heralded by flu-like symptoms such as fever, sore throat, and fatigue. However, the hallmark of the condition is the development of painful, blistering rashes that spread rapidly, accompanied by skin detachment. These rashes typically begin on the face and torso before extending to other parts of the body, including mucous membranes such as the mouth, nose, eyes, and genitals. In severe cases, Stevens-Johnson Syndrome can progress to Toxic Epidermal Necrolysis (TEN), a life-threatening condition characterised by extensive skin loss.

Causes
While the precise etiology of Stevens-Johnson Syndrome remains uncertain, several factors have been implicated in its development. Medications, particularly certain antibiotics and anticonvulsants, are commonly associated with triggering SJS in susceptible individuals. Additionally, viral infections such as herpes and Mycoplasma pneumoniae have been linked to the onset of the syndrome. Genetic predisposition may also play a role, as certain genetic variations have been identified in individuals with a higher susceptibility to developing SJS.

Treatment

Recognition and immediate cessation of the suspected trigger are paramount in managing Stevens-Johnson Syndrome. Hospitalisation in a specialised burn unit is often necessary to provide intensive supportive care, including wound care, fluid and electrolyte management, and pain control. Intravenous immunoglobulin (IVIG) therapy and corticosteroids may be administered to modulate the immune response and reduce inflammation. In severe cases, skin grafting may be required to facilitate wound healing and minimise scarring.

Connection to ibuprofen

While this case was triggered by ibuprofen, a commonly used nonsteroidal anti-inflammatory drug (NSAID), the drug has been the cause in rare cases of SJS and the overall risk remains exceedingly low. The likelihood of developing SJS due to Ibuprofen or other NSAIDs is outweighed by the widespread benefits of these medications in managing pain and inflammation when used appropriately and under medical supervision. SJS can be triggered by epilepsy medication as well.