Carbamazepine‐Induced Stevens‐Johnson Syndrome/Toxic Epidermal Necrolysis Overlap With Severe Ocular and Oral Involvement: A Pediatric Case Report From Uganda

In plain language

An eleven-year-old boy in Uganda developed Stevens-Johnson syndrome and toxic epidermal necrolysis overlap after taking carbamazepine for newly diagnosed epilepsy. Symptoms emerged ten days after starting the medication, featuring fever, facial swelling, photophobia, red eyes, painful mouth ulcers, and skin detachment over more than ten percent of his body. Clinical examination confirmed widespread mucocutaneous damage, including bilateral eyelid swelling, inflamed conjunctiva, crusting around the mouth, erosive oral sores, and a positive Nikolsky sign. Healthcare providers established the diagnosis based on characteristic clinical signs and the timing of drug exposure. Immediate cessation of carbamazepine combined with multidisciplinary supportive care led to significant clinical improvement. The case demonstrates that prompt identification, rapid discontinuation of the trigger medication, and comprehensive supportive care can foster successful outcomes for children with severe drug reactions in resource-limited environments.

Key takeaways

An eleven-year-old boy developed a severe overlap of Stevens-Johnson syndrome and toxic epidermal necrolysis ten days after beginning carbamazepine treatment for epilepsy.
The patient exhibited extensive mucocutaneous symptoms, including epidermal detachment across more than ten percent of his body, severe oral ulceration, and ocular inflammation.
The condition was diagnosed clinically from typical physical findings, including a positive Nikolsky sign, and the clear timeline of medication use.
Immediate discontinuation of carbamazepine paired with multidisciplinary supportive care led to marked recovery in a resource-limited setting.

Why it matters

Severe adverse drug reactions such as Stevens-Johnson syndrome and toxic epidermal necrolysis are dangerous and can rapidly become life-threatening. This report demonstrates that even in resource-limited healthcare settings, early clinical recognition of adverse drug reactions and immediate cessation of the responsible medication can halt disease progression and achieve positive outcomes through supportive multidisciplinary management.

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Abstract

We report a case of carbamazepine-induced Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) overlap in an 11-year-old Ugandan boy who presented with fever, facial swelling, ocular redness with photophobia, painful oral ulceration, and widespread epidermal detachment involving more than 10% of the body surface area. Symptoms developed 10 days after initiation of carbamazepine for newly diagnosed epilepsy. Examination revealed extensive mucocutaneous involvement characterized by bilateral eyelid edema, conjunctival inflammation, perioral hemorrhagic crusting, erosive oral ulcers, and a positive Nikolsky sign. A clinical diagnosis of carbamazepine-induced SJS/TEN overlap was established based on the temporal relationship to drug exposure and characteristic clinical findings. Immediate withdrawal of carbamazepine and multidisciplinary supportive care resulted in marked clinical improvement. This case highlights the importance of early recognition, prompt withdrawal of the offending drug, and multidisciplinary supportive care in improving outcomes for pediatric SJS/TEN, particularly in resource-limited settings.

Research topics

Drug-Induced Adverse Reactions
Contact Dermatitis and Allergies
Forensic Toxicology and Drug Analysis

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