Stevens-Johnson syndrome is an acute, usually drug-induced condition affecting the skin and mucous membranes that can be life-threatening. It is a severe toxic-allergic reaction characterized by skin lesions and involvement of at least two mucous membranes. According to global data, the incidence is about 1.3 cases per million, with a mortality rate reaching 10%. In half of the cases, the cause remains unknown; however, drug allergy poses a particular danger: the risk of sensitization for many medications ranges from 1 to 3%.
Key triggers of the condition include medications such as antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), local anesthetics, antiepileptic drugs, barbiturates, and vaccines. If the reaction occurs within the first four weeks after starting the medication, it can be linked to the drugs taken. SJS requires prompt diagnosis and intensive treatment, and increased age and comorbidities lead to a higher risk of fatal outcomes (from 5 to 12%).
The study describes several clinical cases of SJS development following the use of carbamazepine.
Clinical Case No. 1:
A man born in 1963 was hospitalized in the dermatology department of the Republican Center for Dermatovenereology with symptoms including skin rashes, lesions of the oral mucosa and lips, pain while swallowing, swelling of the lips and hands, and general weakness. He attributed the deterioration of his condition to the use of carbamazepine in the narcology department. After initial therapy, his condition worsened, and the patient was transferred to the RCDV.
During treatment, basic therapy was conducted using glucocorticoids, antihistamines, antibiotics, and antiviral medications, as well as external treatment of the skin and mucous membranes. After 10 days, the patient was discharged with positive dynamics and recommendations, including discontinuation of carbamazepine and adherence to a hypoallergenic diet.
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Clinical Case No. 2:
A man born in 1988 was admitted with widespread skin rashes, lesions of the oral mucosa, eyes, and genital organs, as well as severe pain, itching, and swelling. He had taken carbamazepine again after inpatient treatment in narcology, which triggered an exacerbation of SJS.
Treatment was conducted using a similar scheme with corticosteroids, antihistamines, antibiotics, and antiviral agents, as well as local therapy. After 14 days in the hospital, the patient's condition improved, and he was discharged with recommendations for relapse prevention and discontinuation of carbamazepine.
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Researchers emphasize that it is critically important to conduct timely diagnosis and inform both patients and doctors about the risks associated with drug reactions. Re-prescribing carbamazepine to patients with a history of SJS or other serious skin side effects is strictly prohibited.
Stevens-Johnson Syndrome
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