Drug-Induced Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis as Cutaneous Adverse Events in Palliative Care

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are among the most serious dermatologic pathologies. They are caused by a rapidly developing immune-mediated adverse reaction that is potentially life threatening with a mortality rate of about 30%. The incidence is approximately 1-2 cases/1.000.000 and SJS occurs three times more often than TEN. Sulfonamide antibiotics, anticonvulsants, oxicam-antiphlogistics and allopurinol are known to be high-risk medications. In the literature, a wide variety of other substances are named that can cause this skin reaction. It is mandatory to identify the initiating drug and to withdraw the medication. With palliative patients this can be challenging because they often have a high number of prescriptions (polypharmacy). The therapy of SJS/TEN is complex and a multidisciplinary task. We report the case of a 77-year-old palliative care patient who developed toxic epidermal necrolysis within 2 weeks. We identified hydrochlorothiazide, sertraline, and metamizole (syn: dipyrone) as possibly triggering drugs.