Clinical case: About a Stevens-Johnson syndrome in a child

We report the case of an 8-year-old boy who reported, at age 3.5 year, a Stevens-Johnson syndrome at the second day of a treatment with cefixime, ibuprofen and acetyl-salicylic acid for fever. This treatment had been preceded by a 15-day treatment with oxacillin. Serology for Mycoplasma pneumoniae infection was positive at the time of the reaction, and the concentration of Mycoplasma antibodies increased within the 1.5 following month. Since the reaction, the child tolerated treatments with paracetamol and macrolides, but did not receive any treatment with betalactams. Skin tests with betalactams, ibuprofen and acetyl-salicylic acid (prick, intradermal and patch-tests) gave negative immediate, semi-late, late and hyper-late responses. Challenge/provocation tests with amoxicillin (x 15 days at home), and cefixime, ibuprofen and acetyl-salicylic acid (2 days in the hospital + 2 days at home) were tolerated. Penicillins M were contra-indicated for safety, but all other betalactams and all non-opioid analgesics, antipyretics and nonsteroidal anti-inflammatory drugs were authorized. This case confirms that, in most cases, Stevens-Johnson syndromes in children do not result from drug hypersensitivity but are rather a consequence of the infectious diseases for which the drugs have been prescribed. Also, this case confirms that, in children with Stevens-Johnson syndrome and negative responses in skin tests with the suspected drugs, those drugs should be reintroduced, subjected they are useful or essential. (C) 2012 Elsevier Masson SAS. All rights reserved.