Stevens-Johnson syndrome is a rare, primarily drug-induced, acute condition affecting the skin and mucous membranes, which can be life-threatening. It is a severe toxic-allergic reaction characterized by skin lesions and involvement of at least two mucous membranes. Global statistics indicate that the incidence of severe cases is approximately 1.3 cases per million, with a mortality rate reaching 10%. In 50% of cases, the cause remains unclear; however, drug allergy is particularly dangerous—the risk of sensitization for many medications is 1-3%.
The main triggers of the syndrome include antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), local anesthetics, antiepileptic drugs, barbiturates, and vaccines. If the reaction develops within the first four weeks after starting treatment, it can be linked to the medication. SJS requires rapid diagnosis and intensive therapy; the patient's age and presence of comorbidities increase the likelihood of a fatal outcome (5-12%).
The study describes clinical cases of Stevens-Johnson syndrome caused by the use of carbamazepine.
Clinical Case No. 1:
A male patient born in 1963 was admitted to the dermatology department of the Republican Center for Dermatovenereology with skin rashes, lesions of the oral mucosa and lips, swelling of the lips and hands, as well as general weakness. He attributed his condition to the intake of carbamazepine, which had been prescribed to him in the narcology department. After the first therapy, his symptoms worsened, and he was transferred to the RCDV.
During treatment, the patient was prescribed basic therapy using glucocorticoids, antihistamines, antibiotics, and antiviral agents, as well as topical treatment for the skin and mucous membranes. After 10 days, his condition improved, and he was discharged with recommendations to avoid carbamazepine, adhere to a hypoallergenic diet, and continue supportive therapy.
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Clinical Case No. 2:
A male patient born in 1988 was hospitalized with extensive rashes on the skin, mucous membranes of the mouth, eyes, and genital organs, as well as severe pain, itching, and swelling. The exacerbation of SJS in this patient occurred after the repeated intake of carbamazepine following inpatient treatment in narcology.
Treatment was conducted using a similar scheme with corticosteroids, antihistamines, antibiotics, antiviral agents, and local therapy. After 14 days in the hospital, the patient's condition improved, and he was discharged with recommendations for preventing recurrence and discontinuing carbamazepine.
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Researchers emphasize that the importance of early diagnosis and awareness among both patients and doctors regarding possible drug reactions cannot be overstated. The re-prescription of carbamazepine to those who have previously experienced SJS or other serious skin side effects is strictly prohibited.
Stevens-Johnson Syndrome
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