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Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life‑threatening and severe cutaneous adverse drug reactions characterised by epidermal detachment presenting as blisters and differ only by their extent of skin detachment. A 22‑year‑old male presented to our tertiary care teaching institute with fever for the preceding 5 days and macular rash over the back for the past 1 day. Before this, he had consulted a local physician for fever and was using oral cefuroxime (250 mg bid) for the past 5 days. General physical examination revealed fever (103 oF), conjunctival congestion, generalised maculopapular rash and ulcers over the lips. He was admitted to medical intensive care unit. On the next day, fever persisted; rash had worsened, conjunctivitis developed and skin peeling became evident, involving >10% but <30% of body surface area. At this point in time, a diagnostic possibility of an adverse drug reaction was considered and the patient’s history was thoroughly reviewed again. Oral cefuroxime was stopped. Dermatology consultation was sought. Based on clinical presentation, the patient was diagnosed to have SJS/TEN overlap syndrome. He was treated with intravenous linezolid 600 mg twice daily, topical antibiotics and symptomatic management. The patient recovered, skin lesions subsided and he was discharged from the hospital in a stable condition after 2 weeks of in‑hospital stay. The present case documents the rare occurrence of SJS/TEN overlap syndrome as an adverse drug reaction with cefuroxime treatment. [ABSTRACT FROM AUTHOR]

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but lethal manifestation of hypersensitivity reaction precipitated by certain drugs and viral infections. Among the drugs, it is more common with antibiotics, antiepileptics and nonsteroidal anti-inflammatory drugs. We report the case of a 14-year-old male who presented to the medicine out-patient department with a history of fever since the previous day. Four days before this, he had developed an episode of generalised tonic-clonic seizures and was initiated on oral phenytoin since then. Following admission to the medical intensive care unit, fever persisted on the 2nd day as well. The patient developed a maculopapular rash over face and trunk, ulceration over lips and skin peeling involving >10% <30% body surface area suggestive of SJS/TEN overlap syndrome. Oral phenytoin was stopped, and he was started on oral levetiracetam. He was treated with intravenous corticosteroids, topical antibiotics and symptomatic management. The patient recovered, skin lesions subsided and he discharged in a stable condition after 2 weeks of in-hospital stay. The present case documents the rare occurrence of SJS/TEN overlap syndrome as an adverse drug reaction caused by phenytoin. Early identification and stopping of offending drug will aid in better management of the patient. [ABSTRACT FROM AUTHOR]

Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening and severe cutaneous adverse drug reactions characterised by epidermal detachment presenting as blisters and differ only by their extent of skin detachment. A 22-year-old male presented to our tertiary care teaching institute with fever for the preceding 5 days and macular rash over the back for the past 1 day. Before this, he had consulted a local physician for fever and was using oral cefuroxime (250 mg bid) for the past 5 days. General physical examination revealed fever (103oF), conjunctival congestion, generalised maculopapular rash and ulcers over the lips. He was admitted to medical intensive care unit. On the next day, fever persisted; rash had worsened, conjunctivitis developed and skin peeling became evident, involving >10% but