COVID-19: A Curious Abettor in the Occurrence of Stevens-Johnson Syndrome

Abstract

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are immune-mediated life-threatening skin diseases. The condition is known to be caused by various infections, drugs (mainly antibiotics), or can be idiopathic. Amidst the novel coronavirus 2019 (COVID-19) pandemic, there is an increasing number of SJS/TEN cases being reported. Viral infections are known to have decreased the threshold of drug reactions by inducing a pro-inflammatory state in the body. We report a case of TEN secondary to tamsulosin use in the setting of COVID-19 infection. There is only one documented case of tamsulosin-induced SJS, and no documented case of TEN secondary to tamsulosin use. Our patient was a 26-year-old male who presented to the hospital after a recent history of COVID-19 infection with a diffuse maculo-vesicular rash with bullae, involving the mucosa. The patient had recent use of tamsulosin on the day of presentation and there were bullae and erythematous rashes present in the oral mucosa as well as significant conjunctival erythema with pain on ocular movement on physical examination. His rash progressively worsened, involving greater than 30% of his body. A biopsy was done that showed full-thickness necrosis indicative of toxic epidermal necrolysis (TEN). We hypothesize that in our patient COVID-19 infections lowered the threshold for the development of SJS/TEN.

Acute Kidney Injury Following Posaconazole for Mucormycosis: SARS-CoV-2 as a Back-Seat Driver

“…et al have reported a case of toxic epidermolysis associated with tamsulosin after COVID-19 [3]. This case would add to the list of possible adverse effects of posaconazole and would help internists to consider the renal adverse effects of posaconazole.…”

“…These are either due to direct infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), immune modulation by the virus, or due to the drugs used to treat COVID-19. Viral infections have been reported to induce a pro-inflammatory state in the body which predisposes the patient to a variety of previously unreported adverse reactions to medications [3]. Apart from the immune modulation by SARS-CoV-2, steroids, tocilizumab, and other immunosuppressants used for the treatment of COVID-19 contributed to the emergence of opportunistic infections such as mucormycosis [4].…”

Toxic epidermal necrolysis caused by viral hepatitis A: a case report and literature review

“…and herpes simplex viruses. Human herpes virus (HHV)-6 (1), Epstein-Barr virus (EBV) (2), Mycoplasma pneumoniae (3)(4)(5), and novel coronavirus infection (6,7) are associated with the occurrence and progression of SJS/ TEN. M. pneumoniae and novel coronaviruses can directly cause SJS/TEN.…”

Síndrome de Stevens Johnson secundario a infección por covid-19, primer reporte en Latinoamérica de 1 evento adverso extra pulmonar

“…El SSJ es una dermatosis reactiva, desencadenada por una reacción tardía de hipersensibilidad, mediada por complejos inmunes; se presenta como un eritema multiforme vesiculobulloso, con compromiso de mucosas y síntomas sistémicos, inducido por fármacos más frecuentemente, con algunos casos relacionados a procesos infecciosos y en ocasiones idiopático, con una alta tasa de mortalidad (Ochani, R Et al 2021) (Oakley, A. And Krishnamurthy, K. 2022) (Grover, D Et Al 2022).…”