Successful Management of Etoricoxib-Induced Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis with Corticosteroids: A Case Report
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Abstract
Background: Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare but life-threatening severe cutaneous adverse reactions characterized by widespread epidermal necrosis and detachment, often triggered by medications. Non-steroidal anti-inflammatory drugs (NSAIDs), including selective COX-2 inhibitors like etoricoxib, have been implicated in some cases.
Case Presentation: We report the case of a 59-year-old woman from Rajasthan with a known hypersensitivity to diclofenac who developed SJS following 22 days of etoricoxib therapy for a neck injury. She presented with dyspnoea, dysphagia, painful oral ulcers, erythematous skin lesions, widespread blisters and erosions, and a positive Nikolsky’s sign. The patient was also noted to be malnourished upon examination.
Management: Etoricoxib was immediately discontinued. The patient received systemic antibiotics (piperacillin-tazobactam, clindamycin, doxycycline), corticosteroids (dexamethasone), and supportive care, including fluid and electrolyte replacement, protein supplementation, wound care, and topical treatments. Intravenous immunoglobulins and cyclosporine were not administered due to financial limitations.
Outcome: The patient's condition gradually improved with systemic corticosteroids and supportive measures. She was discharged in a stable state, although some ophthalmic complications persisted.
Conclusion: This case highlights a rare instance of etoricoxib-induced SJS in India. It emphasizes the critical role of clinical judgment in diagnosing and managing drug-induced SJS/TEN, the potential risks associated with NSAIDs, and the importance of vigilant pharmacovigilance and post-marketing drug surveillance to safeguard patient health.