Revealing the risks: stevens-johnson syndrome induced by diclofenac-from pain relief to dermatological crisis

Abstract

Stevens-Johnson Syndrome (SJS) is a rare but potentially fatal skin reaction to medications, frequently triggered by drugs like nonsteroidal anti-inflammatory drugs (NSAIDs), including diclofenac. This case describes a 39-year-old male who developed erythematous lesions and exfoliative dermatitis five days after receiving Diclofenac. The patient exhibited characteristic symptoms of SJS, including widespread skin fragility and a positive indirect Nikolsky sign. Prompt management involved discontinuation of Diclofenac, administration of corticosteroids (Dexamethasone), and immunosuppressants like Cyclosporine to suppress the immune response. Antibiotics (Linezolid and Azithromycin) were used to prevent secondary infections, while topical agents (Miconazole, Betamethasone) addressed skin lesions and fungal colonization. Pharmacists played a key role in this multidisciplinary approach by reviewing the patient's medication history, recommending alternatives to high-risk drugs, and providing education on early signs of adverse drug reactions. Additionally, they monitored immunosuppressant dosing to minimize nephrotoxicity and ensured proper use of topical treatments. Post-discharge follow-up focused on preventing long-term complications such as scarring and chronic mucosal damage. This case underscores the vital contributions of pharmacists in managing drug-induced SJS through vigilant monitoring, patient education, and optimizing pharmacological interventions.