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Stevens-Johnson syndrome: 2 case reports Two women developed Stevens-Johnson syndrome while on fluconazole for candidiasis prophylaxis and prednisolone for hepatic impairment. A 40-year-old woman with alcoholic hepatitis presented with a 5-day history of high fever, malaise, rash, gritty eyes, dysuria and difficulty eating. She had been taking prednisolone 20mg once daily for 28 days and fluconazole 100mg once daily for 13 days. Physical examination showed multiple targetoid lesions and erosions over her chest, back and arms, radiating to the face, covering approximately 10% of her total body surface area, including her oral and vulval mucosae. She also had bilateral conjunctival injection. Skin biopsy revealed an interface vacuolar dermatitis with necrotic keratinocytes, leading to a diagnosis of Stevens-Johnson Syndrome. Fluconazole was discontinued once it was identified as the causative agent [outcome not stated]. A 23-year-old woman with autoimmune hepatitis presented with a maculopapular rash with erosions on her wrist, ankles and across her chest, accompanied by dysuria and gritty, painful eyes. She had been receiving prednisolone 20mg once daily and fluconazole 100mg once daily for 16 days. Physical examination revealed numerous erythematous targetoid lesions on her chest and back and an erythematous papular rash on her arms. There were erosions within her oral cavity, with haemorrhagic crusting on her lips and gum erythema; erosions were also noted on her labia minora. She had bilateral conjunctival injection. A skin biopsy was consistent with erythema multiforme. The clinical features and skin biopsy led to a diagnosis of Stevens-Johnson syndrome, most likely caused by fluconazole with prednisolone modifying the presentation [outcome not stated]. Author comment: "Fluconazole was identified as the most probable causative agent and was stopped in both cases. . . and the presence of moderate-dose corticosteroid may have modified the extent of the acute drug reaction." Craythorne E, et al. Stevens-Johnson syndrome due to prophylactic fluconazole in two patients with liver failure. Clinical and Experimental Dermatology 34: 801154993 e389-e390, No. 7, Oct 2009 - England

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Reactions 9 Jan 2010 No. 1283