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Stevens-Johnson syndrome: case report A 52-year-old woman developed Stevens-Johnson syndrome (SJS) during treatment with esomeprazole, omeprazole and nivolumab for advanced lung adenocarcinoma [routes and dosages not stated; not all indication stated]. The woman with stage-IV lung adenocarcinoma, started receiving treatment with nivolumab. Additionally, she started receiving esomeprazole. After receiving 18 cycles of nivolumab, she achieved partial regression over the metastases of lung, bone and lymph node. However, after the 18th cycle of nivolumab (14 days after the start of esomeprazole), she developed targetoid lesions, blisters, and skin detachment along with oral and genital erosions. A diagnosis of SJS was made. Histological examination showed whole layer epidermal necrosis with diffuse keratinocyte apoptosis and minimal dermal infiltration. As both nivolumab and esomeprazole are known drugs that can cause SJS, both esomeprazole and nivolumab therapies were stopped. The woman then received treatment with unspecified glucocorticoids and frequent wound dressing changes, and recovered completely. After 3 months, she accidentally took esomeprazole, and immediately developed SJS. Hence, esomeprazole was deemed as the main causative drug, and nivolumab was considered as a predisposing factor. Later, she presented with severe oral ulcers with some atypical target lesions on the chest one day after receiving omeprazole. She again received treatment with unspecified glucocorticoids and recovered completely. Due to the development of SJS following the administration of esomeprazole as well as omeprazole, she was advised to avoid the use of esomeprazole and the same class of drugs in future. After 7 months, she was started on ipilimumab instead of nivolumab. No immune-related adverse events were noted thereafter. Eventually, she died due to progression of metastatic lung adenocarcinoma [immediate cause of death not stated]. Lin Y-T, et al. Esomeprazole-induced Stevens-Johnson syndrome in a patient who underwent nivolumab therapy for advanced lung adenocarcinoma. Lung Cancer 148: 803506928 177-178, Oct 2020. Available from: URL: http://doi.org/10.1016/j.lungcan.2020.09.001

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Reactions 17 Oct 2020 No. 1826