Severe Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Misdiagnosed as Varicella: A Case Report
Ànnia Puignau Pont
ABSTRACT
Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, life-threatening severe cutaneous adverse reactions with mortality rates ranging from 10% to 50%. Early recognition and prompt intervention are critical to improve outcomes, yet diagnostic challenges frequently lead to delayed treatment.
Case Presentation: We report the case of a 58-year-old male who developed SJS/TEN with over 30% body surface area involvement following carbamazepine initiation for trigeminal neuralgia. The patient presented with a progressive vesiculopustular rash initially misdiagnosed as an allergic reaction and subsequently as varicella, leading to inappropriate antiviral therapy. Clinical deterioration with extensive blistering and mucosal involvement eventually raised suspicion of SJS/TEN, which was confirmed by skin biopsy. Following transfer to a specialized burn unit and implementation of a multidisciplinary treatment approach, the patient achieved complete recovery.
Conclusion: This case highlights the diagnostic challenges of SJS/TEN, particularly when clinical presentation mimics more common conditions such as varicella or staphylococcal scalded skin syndrome. Early recognition, immediate withdrawal of the culprit drug, and specialized supportive care are essential to reduce morbidity and mortality in these severe cutaneous adverse reactions.
