Carbamazepine triggered Stevens-Johnson syndrome with gastrointestinal and renal system involvement: a case report

Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a rare but life-threatening condition characterized by severe skin and mucosal involvement. Recently, we encountered four cases of Stevens-Johnson syndrome (SJS), three of which were associated with carbamazepine use. This report focuses on one of these cases to highlight the risks associated with this medication. Carbamazepine (CBZ) is recognized as one of its common triggers. This report discusses one of these cases involving an eight-year-old boy weighing 23.3 kg, with a one-year history of epilepsy initially managed with oral sodium valproate, experienced frequent seizures. Consequently, sodium valproate was discontinued, and carbamazepine was started at a dose of 150 mg twice daily. After one week, the dosage was increased to 150 mg in the morning and 300 mg at night. Forty-two days post-initiation of carbamazepine, the patient exhibited fever, cough, and malaise, followed by skin rashes affecting the oral mucosa and eyes three days later. He then developed profuse oral secretions, bloody diarrhea, microscopic hematuria, and albuminuria. The administration of carbamazepine was immediately halted, and the patient was managed in the Pediatric Intensive Care Unit (PICU) by a multidisciplinary team. He achieved full recovery after 35 days. The objective of this case report is to raise awareness of carbamazepine as a potential trigger for SJS, differentiate between Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), and discuss the risk factors, differential diagnosis, and management of SJS/TEN, which often requires a multidisciplinary approach in a pediatric intensive care unit (PICU).