Stevens-Johnson syndrome following use of metronidazole in a dental patient
A 50-year-old nonalcoholic male was diagnosed with erosive lichen planus and prescribed oral vitamins, topical triamcinolone, and oral metronidazole 400 mg twice daily. He took the first dose of metronidazole at 10.30 am and developed burning sensation and itching all over the body around 4 pm the same day. He took cetirizine tablet 5 mg orally on his own and the symptoms abated by evening. Then around 10 pm he took the second dose of metronidazole. After 2 h, he developed severe burning sensation and itching all over the body followed by dizziness, confusion, convulsions, and transient loss of consciousness for a period of 15-20 min. Around 2.30 am, he complained of shivering and palpitation and in the morning, he felt pain over the both feet during walking, redness over the face and neck, and itching and erosion over scrotal skin. He then consulted a general physician, who withdrew metronidazole and had referred him to a dermatologist. He visited the dermatologist the next day by which time he developed fever, ulcers around lips and oral mucosa, difficulty on swallowing and burning sensation during micturition. He had no history of neurological disease. His pulse, blood pressure and other systemic examinations were within normal limits; and he had hemorrhagic encrustation around the lips and oral mucous membrane [], erosion of scrotal skin, creamy urethral discharge, and big blisters over the both planter regions. His routine blood examination was normal except postprandial hyperglycemia (2 h postprandial blood plasma glucose level was 234 mg/dL) and urine examination showed plenty of pus cells, however culture was negative. He was diagnosed clinically and managed as a case of SJS with involvement of approximately 3% of total body surface area. He was treated with oral olopatadine 5 mg, methyl prednisolone 16 mg, famotidine 40 mg once a day, and erythromycin 500 mg thrice daily for 7 days. Methylprednisolone was tapered over the next 14 days. For hyperglycemia, patient had received glimeperide 1 mg orally once daily for 1 week which controlled the blood glucose levels and the patient remained euglycemic even after the drug was withdrawn. The patient recovered without any sequelae in 3 weeks.