Oseltamivir induced Stevens–Johnson syndrome/toxic epidermal necrolysis—case report

Abstract

Rationale: Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are 2 rare but life-threatening diseases characterized by detachment of epidermis, bullous skin lesions, and mucous membrane erosions. Drugs are highly suspected to be the causative agents. We report a case of SJS/TEN induced by oseltamivir, which is a very rare event. Patient concerns: A 9-year-old girl with upper respiratory tract infections presented with generalized maculopapular rash the second day after taking oseltamivir. Diagnosis: The diagnosis of SJS/TEN was made based on cytotoxic skin lesions and mucous membrane involvement. Interventions: After discontinuing of the drug and combination therapy of corticosteroid and human immunoglobulin initiation, the lesions were improved. Human leukocyte antigen (HLA) gene sequencing was done. Outcomes: The girl was followed-up for 1 year. The skin and mucous membranes symptoms were relieved. Lessons: We report this case to attract attention to the rare but serious side effect of this antiviral drug.

Cutaneous sıde‐effects of the potential COVID‐19 drugs

“…13 Oseltamivir can cause Stevens-Johnson syndrome/toxic epidermal necrolysis, angioedema allergic, or idiosyncratic cutaneous drug reactions. 14,15 Umifenovir inhibits membrane fusion of the viral envelope and S protein/ACE2 interaction. It is approved for influenza treatment in Russia and China and a randomized-controlled trial of umifenovir is still going on the anti-COVID -19 agent.…”

Diagnosis and management of the drug hypersensitivity reactions in Coronavirus disease 19: An EAACI Position Paper

“…Drug hypersensitivity reactions to ribavirin, darunavir, LPV/r, remdesivir, and oseltamivir are rarely reported, whereas no DHRs to favipiravir and umifenovir are known at present 46‐51 (Table 2).…”

“…Oseltamivir, used in influenza, causes rare hypersensitivity reactions although close monitoring of patients is important as two cases with Stevens‐Johnson syndrome (SJS)/Toxic epidermal necrolysis (TEN) have been reported, 49,50 with only one being confirmed by LTT 50 . Another case report revealed anaphylaxis due to oseltamivir confirmed by a skin prick test (SPT) 68 (Table 2).…”

COVID-19 and dermatology

“…Oseltamivir has been approved for influenza treatments and may cause cutaneous side effects such as angioedema, Stevens-Johnson syndrome, toxic epidermal necrolysis, etc., however this is rare [81][82][83][84][85].…”