Stevens-Johnson syndrome secondary to the use of non-steroidal anti-inflammatory in a pediatric patient: case report
DOI:
https://doi.org/10.37497/JMRReview.v3i00.69Keywords:
Immunological Reaction, NSAIDs, Pediatrics, Adverse Reactions, Stevens-Johnson SyndromeAbstract
Background: Stevens-Johnson Syndrome (SJS) is a severe skin reaction associated mainly with drugs and infections, characterized by necrosis and detachment of the epidermis and mucous membranes. SJS affects less than 10% of the body surface area (BSA), while toxic epidermal necrolysis (TEN) affects more than 30%, with intermediate cases classified as SJS/TEN. Medications are the most common triggers, although infections such as Mycoplasma pneumonia can also cause the disease. The etiopathogenesis involves type IV hypersensitivity reactions mediated by T cells, with granulysin being an important mediator of keratinocyte apoptosis. Clinically, JSS presents with prodromal symptoms followed by skin and mucosal lesions. Incidence rates vary by region, with a higher prevalence in women, and mortality increases with the severity of the disease.
Aim: To report a case of SJS secondary to the use of non-steroidal anti-inflammatory drugs (NSAIDs) in a pediatric patient.
Method: This is a single case report of a 5-year-old patient seen at the Pediatrics Department of the Hospital Universitário São Francisco na Providência de Deus - HUSF, located in the city of Bragança Paulista – SP, Brazil.
Case Report: This paper describes a 5-year-old girl who developed JSS one day after taking nimesulide. She presented with bullous lesions with an erythematous halo, especially on the palms and soles, as well as sparse lesions on the chest, upper limbs and face, lips and oral mucosa, with exuberant edema, and bilateral conjunctivitis. The patient was treated with methylprednisolone (3 mg/kg/day) and immunoglobulin at a dose of 2 mg/kg, in addition to oxacillin and tobramycin eye drops due to a secondary infection, progressing to complete remission without sequelae.
Conclusion: The use of corticosteroids and immunoglobulin, in addition to antibiotic treatment due to a secondary complication, completely reversed the SJS presented by the patient described, being a suitable therapeutic regimen for future cases similar to the one presented here.
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