Amoxicillin-induced Steven–Johnson syndrome in a 13-year-old female a case report

Abstract

Introduction and importance: Stevens-Johnson syndrome (SJS) is a rare but potentially life-threatening mucocutaneous reaction typically triggered by medications. Although antibiotics are among the known causes, amoxicillin is only rarely implicated. Case presentation: This report highlights a case of amoxicillin-induced SJS in a 13-year-old female of Middle Eastern descent from Iraq, who presented to the emergency department with a 3-day history of exfoliative, painful, burning skin rash accompanied by episodes of bloody vomiting. The patient, with no history of drug allergies, was prescribed amoxicillin for respiratory symptoms. Within 2 days of initiating the medication, she developed a papular rash that rapidly evolved into vesicular lesions with significant mucosal involvement, including painful oral ulcers and cracked lips. Clinical discussion: After a misdiagnosis of chickenpox led to additional medications, her condition further deteriorated, resulting in an emergency department visit and initiation of supportive care. Over the next 10 days, she received intensive management and gradually improved until discharge. Conclusion: This case emphasizes the critical need for clinicians to maintain a high index of suspicion for drug-induced SJS, especially in pediatric patients receiving commonly prescribed antibiotics like amoxicillin. Early recognition and prompt discontinuation of the offending drug are crucial to reduce morbidity and improve patient outcomes.