Successful Treatment of Stevens–Johnson Syndrome with Cyclosporine and Corticosteroid

Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, severe idiosyncratic reactions characterized by extensive necrosis and detachment of the epidermis, commonly triggered by medications. The annual incidence is 1 or 2 cases per million.1 There is usually a prodrome of malaise and fever, followed by rapid onset of erythematous or purpuric macules and plaques that progress to epidermal necrosis and sloughing. SJS and TEN are considered to lie along the same spectrum of disease, differing only in terms of how much of the skin surface is affected. If less than 10% of the body surface is affected, the diagnosis is SJS, and if more than 30% is affected, the diagnosis is TEN; if between 10% and 30% is affected, the diagnosis is SJS–TEN overlap. Although medications such as allopurinol, antibiotics, and antiepileptics are the leading causes in most cases, infections, vaccines, and food have been implicated.1,2 Although fluoroquinolone- associated SJS/TEN has been reported in the literature, the number of cases due to this group of drugs has been relatively small compared with cases due to other drugs. Systemic corticosteroids and immunosuppressive therapies have been used in the management of SJS/TEN, but high-quality evidence supporting their use is lacking